Anti-Müllerian Hormone Levels in the Follicular Fluid of the Preovulatory Follicle: A Predictor for Oocyte Fertilization and Quality of Embryo

This prospective study investigated the relationship between anti-Mullerian hormone (AMH) level in the follicular fluid (FF) and the quality of the oocyte and embryo. A total of 65 FF samples from 54 women were included in this study. FF was collected from the largest preovulatory follicle sized≥20 mm of mean diameter from each ovary. Samples were divided into 3 groups according to the FF AMH levels: below the 33th percentile (low group, FF AMH 3.6 ng/mL, n=22). The quality of the ensuing oocytes and embryos was evaluated by fertilization rate and embryo score. FF AMH levels correlated positively with the matched embryo score on day 3 after fertilization (r=0.331, P=0.015). The normal fertilization rate was significantly lower in the low group than in the intermediate group (61.9% vs. 95.5% vs. 77.3%, respectively, P=0.028). Our results suggest that the FF AMH level could be a predictor of the ensuing oocyte and embryo quality. Graphical Abstract Keywords: Anti-Mullerian Hormone, Follicular Fluid, Oocyte Competence, Embryo Quality, In Vitro Fertilization INTRODUCTION Anti-Mullerian hormone (AMH), also called Mullerian-inhibiting substance, has become known as an important regulator of follicle development (1, 2). It is exclusively produced by granulosa cells of preantral and small antral follicles, presumably independently of follicle-stimulating hormone (FSH) (3, 4, 5). AMH is involved in the inhibition of the growth from primordial to primary follicle as well as in follicle recruitment and selection (3, 4). Moreover, it attenuates the FSH-dependent increase in aromatase activity during early follicle development and reduces the number of LH receptors in FSH-stimulated granulosa cells (5). Serum AMH has been well studied as an excellent marker of ovarian reserve. Serum AMH levels have shown great sensitivity to ovarian aging and significant correlation with antral follicle count, and this relationship was stronger than that for other hormonal markers (6, 7). In addition, it has been a useful predictor of the ovarian response to controlled ovarian stimulation (COS) (8, 9, 10). All of these evidences show that serum AMH quantitatively reflects the size of the ovarian follicle pool; in other words, AMH is a quantitative marker of ovarian reserve and response. Several studies on the serum AMH level showed that AMH levels during COS may reflect the oocyte and embryo quality (1, 11, 12, 13). Studies on the follicular fluid (FF) AMH levels have shown a more direct role of AMH as a regulator of human folliculogenesis (14, 15, 16). Fanchin et al. (14) demonstrated that FF AMH levels of the preovulatory follicle are positively associated with embryo implantation. Takahashi et al. (16) showed that oocytes are more likely to be fertilized when follicles have high concentrations of AMH. However, there have been very few studies on the direct relationship between FF AMH levels and quality of oocyte and embryo and this issue require further study. The objectives of this prospective study were to investigate the relationship between FF AMH levels and the ensuing oocyte and embryo quality and to clarify the role of AMH as a qualitative indicator of ovarian follicular status.