Lower antimüllerian hormone is associated with lower oocyte yield but not live-birth rate among women with obesity

Influencing of serum inflammatory factors on IVF/ICSI outcomes among PCOS patients with different BMI

Introduction

Overweight and obese are important factors leading to the occurrence of long-term complications in women with polycystic ovary syndrome (PCOS). There has been controversy over whether dissatisfaction with pregnancy outcomes in PCOS patients is influenced by chronic inflammatory status or obesity. This retrospective study analyzed the levels of inflammatory factors in PCOS patients with different body mass index (BMI) groups and effective predictors of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancy outcomes.

Methods

There were 273 women with PCOS diagnosed who completed serum inflammatory factors test between January 2017 and June 2022 were selected. The data of 7,649 infertility PCOS patients who received their first IVF/ICSI treatment in the Reproductive Center of Peking University Third Hospital during the period of the study were collected. Finally, 92 PCOS patients were included in the high BMI group, while 97 patients were included in the normal BMI group. Baseline characteristics were collected and the pregnancy outcomes were compared among the two groups. Then, serum inflammatory factors' effect on IVF/ICSI pregnancy outcomes were analyzed with age, anti-Mullerian Hormone (AMH) and BMI adjusted.

Results

PCOS patients in the high BMI group significantly had a lower number of oocytes retrieved and good quality embryos. The high BMI group PCOS patients had higher levels of IL-6 and lower cumulative clinical pregnancy and live birth rates. The level of GM-CSF was higher in the first cycle transfer and cumulative miscarriage group. High TNF-α was negatively correlated with the first transfer cycle and cumulative clinical pregnancy rates after age, AMH and high BMI adjusted. In addition, the cumulative live birth rate was negatively correlated with high IL-6, but the first cycle transfer and cumulative live birth rates were positively correlated with high IL-1β.

Discussion

For PCOS patients, in addition to BMI, attention should also be paid to inflammatory indicators. High levels of TNF-α and IL-6 were negatively correlated with pregnancy outcomes, but high IL-1β was positively correlated with live birth rates among PCOS patients. The level of GM-CSF was higher in miscarriage PCOS patients.

Assessment of Nutritional Status and Its Influence on Ovarian Reserve: A Systematic Review

BACKGROUND

Nowadays, there is a growing interest in the relationship among lifestyle, reproductive health, and fertility. Recent investigations highlight the influence of environmental and lifestyle factors such as stress, diet, and nutritional status on reproductive health. The aim of this review was to determine the influence of nutritional status on ovarian reserve in order to improve the reproductive health of women of childbearing age.

METHODS

A systematic literature review was carried out following the PRISMA method. The quality of the studies was assessed using the Cochrane Collaboration Risk of Bias tool. Data were extracted, and the results were summarized into two blocks: according to the technique used to assess ovarian reserve and nutritional status; according to the results found in the relationship between ovarian reserve and nutritional status.

RESULTS

A total of 22 articles involving 5929 women were included. In 12 of the included articles (54.5%), a relationship between nutritional status and ovarian reserve was demonstrated. In seven publications (31.8%), the increased body mass index (BMI) led to a decrease in ovarian reserve, two of them (0.9%) in patients with polycystic ovary syndrome, showing a decrease only if BMI > 25. In two articles (0.9%), there was a negative relationship between ovarian reserve and waist-to-hip ratio, and in one (0.45%), a positive relationship was shown between ovarian reserve and testosterone levels, the latter being related to body mass index. In five articles (22.7%), body mass index was used as a confounder and was negatively related to ovarian reserve, and in another four (18%), no correlation was found.

CONCLUSIONS

Ovarian reserve appears to be influenced by nutritional status. A high body mass index has a negative impact on the ovary, decreasing antral follicle count and anti-Müllerian hormone. Oocyte quality is compromised, increasing the rate of reproductive problems and the demand for assisted reproductive techniques. Further studies are needed to understand which dietary factors have the greatest effect on ovarian reserve in order to promote reproductive health.

Anti-Müllerian Hormone and Follicle-Stimulating Hormone Are Poor Independent Predictors of Live Birth After Assisted Reproductive Technology

To query if anti-Müllerian hormone (AMH) and/or follicle-stimulating hormone (FSH) predict live birth at the University of Colorado Advanced Reproductive Medicine (CU ARM). This was a retrospective analysis using the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System database at CU ARM from 2017 to 2019 to identify the pregnancy outcomes of the initial fresh or frozen embryo transfer (FET) and their corresponding AMH and FSH. Fisher's exact tests were used to identify differences in pregnancy outcome by age group, and area under the receiver operator characteristic curves was used to quantify live birth prediction. A total of 1083 records from 557 patients were reviewed. After only including the first autologous transfer, 270 cycles were analyzed. Overall live birth (L/B) rate was 58.15% (157/270), which declined with increasing age group (p ≤ 0.01). Although AMH significantly decreased with increasing age (p < 0.001), it was not associated with pregnancy outcome (3.54 ng/mL vs. 3.41 ng/mL, p = 0.56); this relationship was unchanged after controlling for age in logistic regression models (p = 0.52). FSH was also not significantly related to pregnancy outcome (7.00 IU/L vs 6.00 IU/L, p = 0.15), and this relationship did not change after controlling for age (p = 0.61). Using AUC, the only variable predictive of live birth was age (p = 0.002). AMH and FSH are not associated with the probability of live birth. Only age was significantly associated with live birth in this series. AMH and FSH should therefore be used cautiously when counseling patients about ART outcomes.

Anti-Müllerian hormone (AMH) treatment enhances oocyte quality, embryonic development and live birth rate

Anti-Müllerian hormone (AMH) produced by the granulosa cells of growing follicles is critical for folliculogenesis and is clinically used as a diagnostic and/or prognostic marker of female fertility. Previous studies report that AMH-pretreatment in mice creates a pool of quiescent follicles that are released following superovulation, resulting in increased number of ovulated oocytes. However, the quality and developmental competency of oocytes derived from AMH-induced accumulated follicles as well as the effect of AMH treatment on live birth are not known. This study reports that AMH priming positively affects oocyte maturation and early embryonic development culminating in higher number of live births. Our results show that AMH treatment results in good quality oocytes with higher developmental competence that enhances embryonic development resulting in blastocysts with greater gene expression. Transcriptome analysis of oocytes from AMH-primed compared to control mice reveal that AMH upregulates a large number of genes and pathways associated with oocyte quality and embryonic development. Mitochondrial function is the most affected pathway by AMH priming, that is supported by higher number of active mitochondria, mitochondrial DNA content and ATP levels in oocytes and embryos isolated from AMH-primed compared to control animals. These studies for the first time provide an insight into the overall impact of AMH on female fertility and highlight critical knowledge necessary to develop AMH as a therapeutic option to improve female fertility.