The role of ovarian reserve markers in fertility and fertility treatment

Abstract

Ovarian reserve is a key component influencing reproductive function and fertility. Serum anti-Mullerian hormone (AMH) and antral follicle count (AFC) are established quantitative markers of ovarian reserve. The overall aim of this thesis comprising four work packages was to study the role of AMH and AFC on different aspects of fertility and fertility treatment. Their specific objectives were: 1) To compare per-follicle AMH production in various phenotypes of women with polycystic ovary syndrome (PCOS) and with isolated polycystic ovarian morphology (PCOM). 2) To assess the effect of cigarette smoking on quantitative ovarian reserve markers in sub-fertile women, validating self-reported smoking behavior using biomarkers (breath carbon monoxide levels and urine cotinine levels). 3) To assess the effect of treatment with myo-inositol (MI)/di-chiro inositol (DCI) compared to no treatment, placebo or other treatment on markers of ovarian reserve in women with PCOS combining data from published literature. 4) To assess the association between ovarian reserve markers and embryo quality in women undergoing IVF/ICSI treatment using time lapse imaging technology. The work for the thesis included primary research consisting of three single-centre, observational, cross-sectional studies and one evidence synthesis based on a systematic review of published literature. The study population was subfertile women seeking fertility treatment, and the primary outcome measure was ovarian reserve assessed by serum AMH and AFC. A significantly greater per-follicle AMH production observed in anovulatory phenotypes of PCOS may represent a heightened physiological role of AMH leading to ovulatory dysfunction. In our study, exposure to cigarette smoking in women  35 years seeking fertility treatment did not significantly change the antral follicle pool. The biomarkers of ovarian reserve were not significantly associated with the biomarkers of smoking or lifetime smoking exposure. Based on currently available data, our systematic review reported that evidence is lacking for an effect of inositols on altering ovarian reserve markers or subsequent outcomes following IVF/ICSI treatment. We found no significant association between ovarian reserve markers and embryo quality in women undergoing IVF/ICSI treatment. Their positive association with improved pregnancy outcomes following IVF/ICSI is most likely indirect, through the increased numbers of oocytes retrieved.