The predictive value of anti-Müllerian hormone on embryo quality in PGT-A cycles analysis

Objective: Although anti-Müllerian hormone (AMH) is a well-established predictor of oocyte number in assisted reproduction (ART) applications, its potential to reflect embryo quality in ART cycles remains uncertain. This study explored the association between AMH levels and embryo quality, using aneuploidy rates from preimplantation genetic testing for aneuploidy (PGT-A) as an objective indicator of embryo quality.

Methods: A retrospective analysis was performed on patients (excluding those with male factor infertility) who underwent PGT-A at the Reproduction and Genetics Center of Suzhou Municipal Hospital (2018-2022). Patients were stratified by age (<35, 35-37, ≥38 years), body mass index (BMI) (<18.5, 18.5-25, ≥25 kg/m²), number of viable embryos (1-2, 3-4, ≥5), and AMH levels. Group comparisons used independent samples t-test, and correlations with embryo quality were analyzed via logistic regression.

Results: In 542 PGT-A cycles, AMH levels, euploidy and mosaicism rates negatively correlated with age, while, aneuploidy rates were positively correlated with age. BMI group showed AMH levels shows no significant differences between the groups. However, there were significant differences in euploid, aneuploidy rates among the BMI groups(≥25 kg/m²vs <18.5 kg/m²; 18.5–25 kg/m²vs <18.5 kg/m²). Both AMH levels and euploidy rates were positively correlated with the number of viable embryos, while the aneuploidy rate was correlated negatively. The>1.68 ng/mL AMH group had significantly higher euploidy and lower aneuploidy rates. AMH levels negatively correlated with aneuploidy rates.

Conclusion: AMH levels serve as a valuable predictor of embryo quality, with the >1.68 ng/mL group showing better quality than the ≤1.68 ng/mL group. AMH levels strongly correlate with female age and the number of biopsy embryos but not BMI. Embryo quality demonstrated a significant decline with increasing female age and a marked improvement with a higher number of biopsy embryos and higher AMH levels. BMI did not linear correlation with embryo quality, thus cannot be considered an independent predictor of embryo quality.

Introduction

AMH belongs to the β superfamily of transforming growth factor and is a homodimeric glycoprotein (1), which is synthesized by granulosa cells in preantral and small follicles in the ovaries. It influences primordial follicles by regulating the autophagy process through synergistic interactions with other substances (2–4). Follicle-Stimulating Hormone (FSH) is a key hormone that drives the growth and maturation of ovarian follicles. AMH limits the role of FSH in small growing follicles through two core mechanisms: downregulating FSH receptor expression to reduce follicular sensitivity to FSH and inhibiting FSH-mediated follicular growth signaling pathways (5). In summary, AMH is highly concentrated on early-stage follicles: it does not act directly on follicles that have entered the mature stage, but specifically targets small growing follicles that have not yet developed a strong dependence on FSH. By regulating the growth rhythm of these “reserve follicles”, AMH lays the foundation for the long-term stability of ovarian function, and it has been widely used in the clinic to assess ovarian function.

In PGT-A, we need to consider and overcome a number of factors that may have an impact on the outcome, including the patient’s ovarian responsiveness, the ovulation regimen, the initiating dose of gonadotropins (Gn), endometrial tolerance, and the quality of the eggs and embryos (6). It has been shown that the direct factor associated with implantation is the quality of eggs and embryos, while the number of eggs acquired and the number of mature eggs directly affects the number of embryos and the number of good quality embryos (7, 8). Embryonic aneuploidy can be used as an objective qualitative factor to reflect the quality of eggs and embryos, while AMH, as an optimal indicator for assessing ovarian function, is controversial as to whether or not there is a correlation between AMH, as an indicator of ovarian function, and the quality of oocytes and embryos (9–11).

Therefore, in this study, we analyzed 542 PGT-A cycles in our center to find out the relationship between AMH level and the number of embryos obtained and embryo quality, and at the same time statistically analyzed its relationship with age and BMI level, in order to further evaluate whether AMH can be used as a predictor of embryo quality, and to clarify its correlation which can provide some new bases for clinical diagnosis and treatment.

Materials and methods

Study objects

Patients (without male factor) who underwent PGT-A at the Center for Reproduction and Genetics of Suzhou Municipal Hospital from 2018–2022 were collected for retrospective analysis, and a total of 2,171 embryos from 542 cycles were included in the study. Exclusion criteria: known uterine malformations, pathologic endometrial changes, uterine adhesions, autoimmune diseases, etc. Female age, BMI, AMH, and number of viable embryos were summarized and counted(Figure 1). The study subjects signed the relevant informed consent. The research was approved by the Ethics Committee of Suzhou Municipal Hospital before it was conducted.

Figure 1

Figure 1. Flowchart of patient screening and stratification of female age, BMI, number of viable embryos, and AMH levels.

Anti-Müllerian hormone testing

Before the start of the ART cycle, peripheral blood was collected from female patients on the 2nd-3rd day of menstruation for serum AMH testing. Serum AMH levels are measured using a second-generation enzyme-linked immunosorbent assay (Immunotech, Beckman Coulter Inc., USA). Samples can be accurately measured within the analytical range of the lower limit of detection and the highest calibration value (approximately 0.02–24 ng/mL [0.14–171 pmol/L]).

Embryonic aneuploidy detection

The IVF cycle used a long protocol or a GnRH (gonadotropin-releasing hormone) antagonist protocol to control ovarian hyperstimulation. Oocytes were collected after hCG injection 34-35hours, and fertilized by single sperm intracytoplasmic injection (ICSI). All embryos were incubated with laser technique on day 3 and then placed in fresh medium until day 5 or 6 after which they could be considered for biopsy if they had developed into complete blastomeres. Whole genome amplification (REPLI-g Single Cell WGA Kit, Qiagen, Germany)was performed on all biopsy samples and then libraries were constructed. After isothermal amplification and enrichment, sequencing was performed using a PGM sequencer (ABI Ion Torrent PGM, USA). Sequencing results were interpreted using Ion Reporter software, and chromosome analysis was performed by analyzing the data through the interface or the background linux interface to determine the aneuploidy of the embryos.

Group analysis

Participants were categorized based on age (<35, 35-37, ≥38), body mass index (BMI) (<18.5 kg/m², 18.5–25 kg/m², ≥25 kg/m²), the number of embryos available for biopsy (1-2, 3-4, ≥5), and AMH levels (≤1.68 ng/ml, >1.68 ng/ml).

Statistical methods

Euploidy rate, defined as the number of euploid blastocysts divided by the number of biopsied blastocysts per cycle. Aneuploidy rate, defined as the number of aneuploidy blastocysts per cycle divided by the number of biopsy blastocysts. Statistical analysis was performed using SPSS 19.0. Normally distributed quantitative data were expressed as mean ± standard deviation (Mean ± SD). Independent samples t-test was used for comparison between groups; P<0.05 was considered as statistically significant difference. Logistic regression was used to evaluate the association between aneuploidy rate and female age, BMI, number of viable embryos, and AMH levels.

Results

Comparison of AMH and embryo quality analysis results stratified by age

In 542 PGT-A cycles, stratified by age(<35, 35-37, ≥38), the AMH level(5.31 ± 4.3 vs. 3.12 ± 2.79vs. 2.22 ± 1.84), the euploidy rate of embryos(0.54 ± 0.3 vs. 0.44 ± 0.32vs. 0.25 ± 0.33), and the mosaicism rate(0.18 ± 0.23 vs. 0.13 ± 0.21vs. 0.07 ± 0.19)exhibited a negative correlation with age, whereas the aneuploidy rate demonstrated a positive correlation with age (0.27 ± 0.27 vs. 0.43 ± 0.33vs. 0.67 ± 0.36) (Table 1). The t-test showed that there were significant differences between all two groups of analyses. The logistic regression analysis showed the strongest positive correlation between age and percentage of aneuploid embryos (P<0.0001, R² = 0.2751) (Figure 2).

Table 1

Table 1. AMH and embryo quality analysis results stratified by age. .

Figure 2

Figure 2. The logistic regression analysis for aneuploidy rate (age, BMI, the number of embryos that can be biopsied and AMH).

Comparison of AMH and embryo quality analysis results stratified by BMI

BMI(<18.5 kg/m², 18.5–25 kg/m², ≥25 kg/m²), AMH levels(4.3 ± 3.55 vs. 4.84 ± 3.37vs. 3.77 ± 2.54) shows no significant differences between the groups. However, there were significant differences in euploid(p=0.002, 0.24 ± 0.23 vs. 0.46 ± 0.34; p<0.0005 0.27 ± 0.22 vs. 0.46 ± 0.34), aneuploidy rates(p=0.002, 0.67 ± 0.26 vs. 0.44 ± 0.37; p<0.0005 0.63 ± 0.27 vs. 0.44 ± 0.37) among the BMI groups(BMI≥25 kg/m²vs <18.5 kg/m²; 18.5–25 kg/m²vs <18.5 kg/m²) (Table 2). Nevertheless, the correlation was not observed between BMI and aneuploid embryos from the logistic regression analysis (Figure 2).

Table 2

Table 2. AMH and embryo quality analysis results stratified by BMI.

Comparison of AMH and embryo quality analysis results stratified by the number of embryos that can be biopsied

When stratified by the number of embryos available for biopsy (1-2, 3-4, ≥5), both the AMH level(2.04 ± 2.01 vs. 3.37 ± 2.65vs. 5.75 ± 4.4) and the euploidy rate of embryos(0.29 ± 0.4 vs. 0.41 ± 0.3vs. 0.53 ± 0.24) were positively correlated with the number of biopsied embryos, whereas the aneuploidy rate(0.59 ± 0.44 vs. 0.46 ± 0.31vs. 0.34 ± 0.25) was negatively correlated with the number of biopsied embryos (Table 3). The t-test showed that there were significant differences between all two groups of analyses except the mosaicism rate group. The logistic regression analysis showed significant negative correlation between the number of biopsied embryos and percentage of aneuploid embryos (P<0.0001), but this association is not particularly robust (R² = 0.0564) (Figure 2).

Table 3

Table 3. AMH and embryo quality analysis results stratified by the number of embryos that can be biopsied.

Comparison of embryo quality analysis results stratified by AMH

Stratification by AMH level (≤1.68 ng/ml, >1.68 ng/ml) revealed the x̅ ± SD for each parameter; the euploidy rate of embryos was significantly higher in the >1.68 ng/ml group compared to the ≤1.68 ng/ml group (P = 0.017, 0.35 ± 0.38 vs. 0.42 ± 0.32)and aneuploidy rate of embryos was significantly lower(P = 0.025, 0.53 ± 0.40 vs. 0.45 ± 0.35). (Table 4). The logistic regression analysis showed significant negative correlation between AMH level and percentage of aneuploid embryos (P<0.0001), but the strength of correlation remaining moderate (R² = 0.0502) (Figure 2).

Table 4

Table 4. Embryo quality analysis results stratified by AMH.

Discussion

Currently, assisted human reproduction technology has significantly advanced; however, enhancing the clinical pregnancy rate remains a subject warranting further investigation. AMH, a peptide mainly secreted by the gonads, plays a crucial role in human reproduction. It operates independently of the menstrual cycle and exhibits autocrine, endocrine, and paracrine functions within the reproductive system. AMH’s significance in the field of assisted reproduction stems from its correlation with a woman’s age and the number of antral follicles, making it a valuable marker for assessing ovarian reserve and ovarian response during ovulation induction. Nonetheless, its predictive value for embryo quality and pregnancy outcomes remains inconclusive (12–16).

In this study, by retrospectively analyzing 542 patients in PGT-A cycles, categorized by age, BMI, number of biopsied embryos, and AMH levels, we found a significant correlation between female age and embryo quality. The relationship between female age and embryo quality can be attributed to the impact of oocyte quality on embryo quality. It is well-documented that age-related declines in ovarian reserve and oocyte quality can hinder the development of fertilized eggs, leading to a higher rate of aneuploidy (17), which is align with the findings of this study. In addition, we found that the mosaicism rate of embryos decreased significantly in the older age group, as the reports said mosaicism were more prevalent among younger patients (18, 19), which may indicate that with age, the embryo’s ability to self-repair chromosomal abnormalities in the early cleavage decreases, which corresponds to a decrease in mosaicism.

Prior studies have shown that BMI has an inverse association with AMH levels in patients with polycystic ovarian syndrome (PCOS) (20, 21), but our data showed no difference between AMH and BMI in PGT-A cycles. Grouping by BMI revealed no correlation with AMH values but with embryo quality, the euploid and aneuploidy rates of the embryos show statistically significant differences (≥25 kg/m²vs <18.5 kg/m²; 18.5–25 kg/m²vs <18.5 kg/m²). Our previous data (unpublished) have shown that weight loss in some PGT patients leads to a higher number of euploid embryos in subsequent PGT cycles. This suggests that individual weight regulation may improve embryo quality. But other studies investigated the number and percentage of euploid, aneuploid and mosaic embryos did not vary according to BMI (22, 23), further studies involving larger cohorts are necessary. However, high BMI also can lead to an increased risk of miscarriage after euploid embryo transfer (24), these women trying to become pregnant should be advised weight reduction before pregnancy.

Some studies have shown that the pregnancy rate increases with the increase of the number of eggs while acquired eggs ≤ 15, the pregnancy rate does not change significantly between 15 and 20 eggs acquired, and the pregnancy rate decreases with the increase of the number of eggs acquired when the number of eggs acquired is > 20 (25), which shows that the number of eggs acquired is not the more the better, but the quality of the eggs and the quality of the embryos that are formed afterward is more important. At this stage, all the embryos available for biopsy in our center are relatively high-quality 5-6-day blastocysts, which to some extent reflects the quality of the embryos. At this stage, AMH serves as an excellent indicator of ovarian reserve, with numerous studies establishing models to predict oocyte yield based on AMH levels (26), and our statistics grouped according to the number of embryos biopsied demonstrated a strong linear correlation with AMH levels, which can also be considered for further prediction of the number of embryos biopsied. In addition, our results show that the number of embryos biopsied is positively correlated with the euploidy rate of embryos and negatively correlated with the aneuploidy rate of embryos, which can be a good predictor of PGT-A outcome.

Grouping by AMH values showed significant difference in embryo quality between the low (≤1.68 ng/mL) and the high AMH group (>1.68 ng/mL). We selected 1.68 ng/mL (12 pmol/L) as the AMH cutoff based on Arce et al. (27), who demonstrated its superiority in predicting both low oocyte yield and cumulative live birth rate—outcomes directly relevant to PGT-A success—compared to thresholds focused solely on poor ovarian response diagnosis (28, 29). Given the predictive value of AMH levels for embryo quality, they can be used clinically to anticipate oocyte and embryo conditions and guide ovulation induction protocols. Previous papers have also been controversial on whether AMH is correlated with aneuploidy rates in embryos. For example, Pipari’s report concluded that AMH is not correlated with aneuploidy rates (30), but the correlation between age and aneuploidy rates in synchronous statistics did not reach a very significant difference, which is also inconsistent with the statistical results of other papers (31, 32).Although female age is more favorable than AMH in predicting aneuploidy in embryos, younger women with lower ovarian reserve appeared to have better outcomes than older women with good ovarian reserve, higher AMH values may partially mitigate the age-related decline in live birth rates in older women (33). When comparing AMH and female age, AMH is a superior predictor of oocyte yield, miscarriage and live birth compared to female age (34, 35).

In conclusion, combining the results of the present study and previous studies, serum AMH levels were found to be strongly associated with female age and the number of embryos biopsied. AMH levels also serve as a valuable predictor of embryo quality. Therefore, it can be used as a reference indicator to predict embryo quality when factors such as age are not effective. In our follow-up work, we can also try to establish a relevant model to predict embryo quality by AMH value. Our data can help individualized counseling for patients preparing for PGT-A. Since this study was based on a limited number of cases and data from a single center, these findings need to be confirmed by a larger cohort study.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving humans were approved by The ethics committee of Suzhou Municipal Hospital. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

Author contributions

MN: Writing – original draft, Conceptualization, Formal analysis, Investigation, Writing – review & editing. HZ: Formal analysis, Writing – original draft, Writing – review & editing. JS: Investigation, Writing – review & editing. GZ: Visualization, Writing – review & editing. SX: Validation, Writing – original draft. AZ: Resources, Writing – original draft. YP: Writing – original draft, Software. GL: Validation, Writing – original draft. JD: Investigation, Writing – original draft. QM: Visualization, Writing – original draft. HL: Methodology, Writing – review & editing. JF: Resources, Writing – review & editing. JO: Writing – review & editing, Conceptualization, Data curation, Investigation, Project administration, Resources, Supervision, Writing – original draft.

Funding

The author(s) declared that financial support was received for this work and/or its publication. This research was supported by Jiangsu Provincial Medical Key Discipline (Laboratory) (JSDW202214).

Conflict of interest

Author HZ and JF were employed by the company Peking Jabrehoo Med Tech Co., Ltd.

The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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The author(s) declare that no Generative AI was used in the creation of this manuscript.

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References

1. Bedenk J, Vrtacnik-Bokal E, and Virant-Klun I. The role of Anti-müllerian hormone (AMH) in ovarian disease and infertility. J Assist Reprod Genet. (2020) 37:89–100. doi: 10.1007/s10815-019-01622-7

PubMed Abstract | Crossref Full Text | Google Scholar

2. Ye H. Significance of serum anti-müllerian hormone testing in IVF. J Reprod Med. (2015) 24:1–4. doi: 10.3969/j.issn.1004-3845.2015.01.001

Crossref Full Text | Google Scholar

3. Kumariya S, Ubba V, Jha RK, and Gayen JR. Autophagy in ovary and polycystic ovary syndrome: role, dispute and future perspective. Autophagy. (2021) 17:2706–33. doi: 10.1080/15548627.2021.1938914

PubMed Abstract | Crossref Full Text | Google Scholar

4. Bressler H and Steiner A. Anti-müllerian hormone as a predictor of reproductive potential. Curr Opin Endocrinol. (2018) 25:385–90. doi: 10.1097/MED.0000000000000440

PubMed Abstract | Crossref Full Text | Google Scholar

5. Pellatt L, Rice S, Dilaver N, Heshri A, Galea R, Brincat M, et al. Anti-Müllerian hormone reduces follicle sensitivity to follicle-stimulating hormone in human granulosa cells. Fertility Sterility. (2011) 96:1246–51. doi: 10.1016/j.fertnstert.2011.08.015

PubMed Abstract | Crossref Full Text | Google Scholar

6. Preaubert L, Shaulov T, Phillips S, Stutz M, Kadoch IJ, Sylvestre C, et al. Live birth rates remain sta ble in modified natural IVF despite low anti-Müllerian hormone: analysis of 638 cycles. Reprod BioMed Online. (2019) 39:461–6. doi: 10.1016/j.rbmo.2019.04.011

PubMed Abstract | Crossref Full Text | Google Scholar

7. Li XL, Huang R, Fang C, and Liang XY. Basal serum anti-Müllerian hormone level as a predictor of clinical outcomes in freezing-all embryo transfer program. .Curr Med Sci. (2018) 38:861–7. doi: 10.1007/s11596-018-1954-6

PubMed Abstract | Crossref Full Text | Google Scholar

8. Zhang X and Long Z. Predictive evaluation of ovarian reserve function by anti-Müllerian hormone and sinus follicle number. Chin J Eugenics Genet. (2015) 23:2116–117. doi: 10.13404/j.cnki.cjbhh.2015.07.055

Crossref Full Text | Google Scholar

9. Hamdine O, Eijkemans MJ, Lentjes EW, Torrance HL, Macklon NS, Fauser BC, et al. Ovarian response prediction in GnRH antagonist treatment for IVF using anti-Müllerian hormone. Hum Reprod. (2015) 30:170–8. doi: 10.1093/humrep/deu266

PubMed Abstract | Crossref Full Text | Google Scholar

10. Von Wolff M, Roumet M, Stute P, and Liebenthron J. Serum anti-Müllerian hormone (AMH) concentration has limited prognostic value for density of primordial and primary follicles, questioning it as an accurate parameter for the ovarian reserve. . Int J Study Climact. (2020) 134:34–40. doi: 10.1016/j.maturitas.2020.02.001

PubMed Abstract | Crossref Full Text | Google Scholar

11. Chen YH, Wang Q, Zhang Y, Xu XH, Lu J, Zhang SD, et al. Predictive value of anti-Müllerian hormone and age on clinical outcomes in in vitro fertilization-embryo transfer. Chin J Obstetrics Gynecology. (2019) 54:239–44. doi: 10.3760/cma.j.issn.0529-567x.2019.04.005

PubMed Abstract | Crossref Full Text | Google Scholar

12. Zhang M. Anti-mullerian hormone and ovarian function. Prog Modern Obstetrics Gynecology. (2010) 19:305–7. doi: 10.13283/j.cnki.xdfckjz.2010.04.016

Crossref Full Text | Google Scholar

13. Goswami M and Nikolaou D. Is AMH level, independent of age, a predictor of live birth in IVF? J Hum Reprod Sci. (2017) 10:24–30. doi: 10.4103/jhrs.JHRS_86_16

PubMed Abstract | Crossref Full Text | Google Scholar

14. Jaswa EG, McCulloch CE, Simbulan R, Cedars MI, and Rosen MP. Diminished ovarian reserve is associated with reduced euploidy rates via preimplantation genetic testing for aneuploidy independently from age: evidence for concomitant reduction in oocyte quality with quantity. Fertil Steril. (2021) 115:966–73. doi: 10.1016/j.fertnstert.2020.10.051

PubMed Abstract | Crossref Full Text | Google Scholar

15. Morales HSG, López GGP, Cortés DV, Torres GCR, Hernández HS, Guiot ML, et al. Evaluation of the anti-Müllerian hormone and its association with embryo quality in advanced reproductive treatments in a latin american population. JBRA Assist Reprod. (2022) 26:50–2. doi: 10.5935/1518-0557.20210050

PubMed Abstract | Crossref Full Text | Google Scholar

16. Li HJ, Seifer DB, and Reshef T. AMH independently predicts aneuploidy but not live birth per transfer in IVF PGT-A cycles. Reprod Biol Endocrin. (2023) 21:19. doi: 10.1186/s12958-023-01066-w

PubMed Abstract | Crossref Full Text | Google Scholar

17. Mullen RD, Wang Y, Liu B, Moore EL, and Behringer RR. Osterix functions downstream of anti-Müllerian hormone signaling to regulate Müllerian duct regression. Proc Natl Acad Sci U S A. (2018) 115:8382–7. doi: 10.1073/pnas.1721793115

PubMed Abstract | Crossref Full Text | Google Scholar

18. Armstrong A, Kroener L, Miller J, Nguyen A, Kwan L, and Quinn M. The nature of embryonic mosaicism across female age spectrum: an analysis of 21,345 preimplantation genetic testing for aneuploidy cycles. . F S Rep. (2023) 4:256–61. doi: 10.1016/j.xfre.2023.03.008

PubMed Abstract | Crossref Full Text | Google Scholar

19. Cascales A, Morales R, Castro A, Ortiz JA, Lledo B, Ten J, et al. Factors associated with embryo mosaicism: a systematic review and meta-analysis. J Assist Reprod Genet. (2023) 40:2317–24. doi: 10.1007/s10815-023-02914-9

PubMed Abstract | Crossref Full Text | Google Scholar

20. Kloos J, Perez J, and Weinerman R. Increased body mass index is negatively associated with ovarian reserve as measured by anti-Müllerian hormone in patients with polycystic ovarian syndrome. Clin Obes. (2023) 14:e12638.

PubMed Abstract | Google Scholar

21. Li X, Tang Q, Feng Y, Zhang Y, Tian W, and Zhang H. The relationship between anti-müllerian hormone and body composition components in patients with polycystic ovary syndrome of reproductive age. Reprod Sci. (2024) 31:2843–8. doi: 10.1007/s43032-024-01561-4

PubMed Abstract | Crossref Full Text | Google Scholar

22. Goldman KN, Hodes-Wertz B, McCulloh DH, Flom JD, and Grifo JA. Association of body mass index with embryonic aneuploidy. Fertil Steril. (2015) 103:744–8. doi: 10.1016/j.fertnstert.2014.11.029

PubMed Abstract | Crossref Full Text | Google Scholar

23. Stovezky YR, Romanski PA, Bortoletto P, and Spandorfer SD. Body mass index is not associated with embryo ploidy in patients undergoing in vitro fertilization with preimplantation genetic testing. Fertil Steril. (2021) 116:388–95. doi: 10.1016/j.fertnstert.2021.02.029

PubMed Abstract | Crossref Full Text | Google Scholar

24. Cozzolino M, García-Velasco JA, Meseguer M, Pellicer A, and Bellver J. Female obesity increases the risk of miscarriage of euploid embryos. Fertil Steril. (2021) 115:1495–502. doi: 10.1016/j.fertnstert.2020.09.139

PubMed Abstract | Crossref Full Text | Google Scholar

25. Nakhuda GS, Sauer MV, Wang JG, Ferin M, and Lobo RA. Müllerian inhibiting substance is an accurate marker of ovarian response in women of advanced reproductive age undergoing IVF. Reprod BioMed Online. (2007) 14:450–4. doi: 10.1016/S1472-6483(10)60892-9

PubMed Abstract | Crossref Full Text | Google Scholar

26. Lin PY, Huang FJ, Kung FT, Chiang HJ, Lin YJ, Lin YC, et al. Evaluation of serum anti-Müllerian hormone as a biomarker of early ovarian aging in young women undergoing IVF/ICSI cycle. Int J Clin Exp Patho. (2014) 7:6245–53.

PubMed Abstract | Google Scholar

27. Arce JC, La Marca A, Mirner Klein B, Nyboe Andersen A, and Fleming R. Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients. Fertil Steril. (2013) 99:1644–53. doi: 10.1016/j.fertnstert.2012.12.048

PubMed Abstract | Crossref Full Text | Google Scholar

28. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, and Gianaroli L. ESHRE working group on Poor Ovarian Response Definition. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. (2011) 26:1616–24. doi: 10.1093/humrep/der092

PubMed Abstract | Crossref Full Text | Google Scholar

29. Wang X, Jin L, Mao YD, Shi JZ, Huang R, Jiang YN, et al. Evaluation of ovarian reserve tests and age in the prediction of poor ovarian response to controlled ovarian stimulation-A real-world data analysis of 89,002 patients. Front Endocrinol (Lausanne). (2021) 12:702061. doi: 10.3389/fendo.2021.702061

PubMed Abstract | Crossref Full Text | Google Scholar

30. Pipari A, Guillen A, Cruz M, Pacheco A, and Garcia-Velasco JA. Serum anti-Müllerian hormone levels are not associated with aneuploidy rates in human blastocysts. Reprod BioMed Online. (2021) 42:1211–8. doi: 10.1016/j.rbmo.2021.03.006

PubMed Abstract | Crossref Full Text | Google Scholar

31. La Marca A, Minasi MG, Sighinolfi G, Greco P, Argento C, Grisendi V, et al. Female age, serum antimüllerian hormone level, and number of oocytes affect the rate and number of euploid blastocysts in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. (2017) 108:777–83. doi: 10.1016/j.fertnstert.2017.08.029

PubMed Abstract | Crossref Full Text | Google Scholar

32. Arnanz A, Bayram A, Elkhatib I, Abdala A, El-Damen A, Patel R, et al. Antimüllerian hormone (AMH) and age as predictors of preimplantation genetic testing for aneuploidies (PGT-A) cycle outcomes and blastocyst quality on day 5 in women undergoing in vitro fertilization (IVF). J Assist Reprod Genet. (2023) 40:1467–77. doi: 10.1007/s10815-023-02805-z

PubMed Abstract | Crossref Full Text | Google Scholar

33. Harris BS, Acharya KS, Weber JM, Truong T, and Eaton JL. Can high antimüllerian hormone mitigate some of the age-related decline in live birth rates? the association between antimüllerian hormone and live birth among women over 40 undergoing in vitro fertilization. F&S Rep. (2021) 2:440–7. doi: 10.1016/j.xfre.2021.08.009

PubMed Abstract | Crossref Full Text | Google Scholar

34. Nelson SM, Klein BM, and Arce JC. Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials. Fertil Steril. (015) 103:923–30. doi: 10.1016/j.fertnstert.2014.12.114

PubMed Abstract | Crossref Full Text | Google Scholar

35. Tarasconi B, Tadros T, Ayoubi JM, Belloc S, de Ziegler D, and Fanchin R. Serum antimüllerian hormone levels are independently related to miscarriage rates after in vitro fertilization embryo transfer. Fertil Steril. (2017) 108:518–24. doi: 10.1016/j.fertnstert.2017.07.001

PubMed Abstract | Crossref Full Text | Google Scholar