In this study, 714 women, who underwent the first IVF treatment cycle, fulfilled the inclusion criteria, were included. The clinical and demographic parameters of the included subjects were listed in Table 2.
The correlation between AMH and AFC was visualized in Figure 1. A significant positive association of AMH and AFC was depicted in the entire study population (regression equation: AMH = 0.4167 × AFC; R2= 0.462, P < 0.001).
To better elucidate the relationship between AMH and AFC, the two ovarian reserve markers were stratified into the following categories. The interquartile range (IQR) value of serum AMH concentration was 2.05-5.58 ng/mL, whereas which of AFC was 12-31. Patients were grouped according to whether their AMH and AFC values were in the lower quartile, upper quartile, or in between (Table 1).
Table 1 Grouping of the entire study subjects based on the interquartile range (IQR) values of serum AMH concentration(ng/mL) and AFC.
AMH
(ng/mL)
|
AFC
|
<12
|
12-31
|
>31
|
|
<2.05
|
①
|
②
|
③
|
|
|
124
|
49
|
5
|
178
|
2.05-5.58
|
④
|
⑤
|
⑥
|
|
|
43
|
249
|
67
|
359
|
>5.58
|
⑦
|
⑧
|
⑨
|
|
|
0
|
76
|
101
|
177
|
|
167
|
374
|
173
|
714
|
As shown in Table 1, subjects in ①, ⑤, and ⑨ (474 out of 714, 66.39%) , had a concordance in AMH and AFC. In the rest 240 subjects (240 out of 714, 33.61%), those in ④, ⑦, and ⑧ had AMH concentration higher than predicted(HTP) according to AFC (119 out of 714, 16.67%), while those in ②, ③, and ⑥ had it lower than predicted(LTP) according to AFC (121 out of 714, 16.94%). Patients were then divided into three groups based on the concordance between AMH and AFC levels provided by Table 1:
Group A (Concordant): ① + ⑤ + ⑨ (AMH<2.05 ng/mL and AFC<12, AMH 2.05-5.58 ng/mL and AFC 12-31, AMH>5.58 ng/mL and AFC>12);
Group B (HTP): ④ + ⑦ + ⑧ (AMH 2.05-5.58 ng/mL and AFC<12, AMH>5.58ng/mL and AFC≤31);
Group C (LTP): ② + ③ + ⑥ (AMH<2.05 ng/mL and AFC≥12, AMH 2.05-5.58 ng/mL and AFC>31).
The clinical and biochemical characteristics of subjects after grouping were presented in Table 2. As seen in Table 2, the three cohorts had similar age, infertile duration, FSH, Estradiol, PRL, LH, Testosterone, and CA125 levels.
Table 2 Comparison of clinical and biochemical characteristics of patients in different groups. P < 0.05 was considered statistically significant. Data were presented as n (%) or mean ± standard deviation (SD).
Variables
|
Group A
(Concordant)
(N=474)
|
Group B
(HTP)
(N=119)
|
Group C
(LTP)
(N=121)
|
Total
(N=714)
|
P
|
Age (years)
|
30.07±4.59
|
29.54±4.08
|
29.29±4.43
|
29.85±4.49
|
0.059
|
BMI (kg/m2)
|
22.65±3.43
|
22.56±3.46
|
23.81±3.87
|
22.83±3.54
|
0.015*
|
Infertile duration
(years)
|
3.41±2.63
|
3.32±2.36
|
3.31±2.53
|
3.38±2.57
|
0.914
|
FSH (mIU/mL)
|
7.85±3.24
|
7.18±1.99
|
7.09±2.04
|
7.61±2.90
|
0.082
|
Estradiol (pg/mL)
|
51.89±32.24
|
52.29±20.15
|
50.57±22.82
|
51.73±29.06
|
0.367
|
PRL (pg/mL)
|
277.46±132.39
|
299.48±148.77
|
279.09±129.20
|
281.41±134.78
|
0.589
|
LH (pg/mL)
|
5.11±3.16
|
5.31±3.45
|
5.07±3.33
|
5.13±3.23
|
0.711
|
Testosterone (ng/mL)
|
0.54±2.52
|
0.68±2.72
|
0.43±0.15
|
0.54±2.33
|
0.512
|
CA125 (U/mL)
|
17.46±10.12
|
16.24±7.84
|
16.78±8.79
|
17.14±9.56
|
0.579
|
AFC
|
22.21±15.19
|
18.22±8.70
|
30.55±12.37
|
22.96±14.33
|
0.000*
|
AMH (ng/mL)
|
4.20±3.44
|
5.82±2.66
|
3.01±1.56
|
4.27±3.18
|
0.000*
|
Fully mature retrieved oocytes(n)
|
333
(70.25%)
|
74
(62.18%)
|
93
(76.86%)
|
500
|
0.045*
|
Interestingly, BMI (P=0.015) progressively increased from Group B(HTP) to Group A(Concordant) and to Group C(LTP) (from 22.56±3.46 kg/m2 to 22.65±3.43 kg/m2 and to 23.81±3.87 kg/m2, P=0.015). The ratio of patients, who had completely mature oocytes (COM), rapidly decreased from Group C(LTP) to Group A(Concordant) and to Group B(HTP) (from 76.86% to 70.25% and to 62.18%, P=0.045).
According to BMI, general population is classified into five categories: underweight (BMI<18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), class I obesity-overweight (BMI 25.0-29.9 kg/m2), class II obesity -obesity (BMI 30.0-39.9 kg/m2), and class III obesity -extreme obesity (BMI≥40 kg/m2). The range of BMI in this study sample was 14.90-36.10 kg/m2. To get a better understanding of BMI-related AMH and AFC discordance, women were subdivided into the following groups on account of the above BMI classification criteria (Table 3, P=0.009). The upper numbers were the observed values, and the numbers in the brackets were the expected ones. As shown in Table 3, the observed value in Group A (concordant) was notably higher than the expected one when BMI≤24.9 kg/m2 (BMI<18.5 kg/m2 and BMI 18.5-24.9 kg/m2), which means in this BMI region, concordant in AMH and AFC was more common. Concurrently, the corresponding situation in Group B (HTP) generally occurred when BMI<18.5 kg/m2 and BMI 25.0-29.9 kg/m2, while in Group C (LTP), widely appeared when BMI≥25.0 kg/m2 (BMI 25.0-29.9 kg/m2 and BMI 30.0-39.9 kg/m2).
Table 3 The number of patients in different groups sub-stratified according to BMI categories. P < 0.05 was considered statistically significant. Data were presented as n (%).
BMI classification
(kg/m2)
|
Group A
(Concordant)
(N=474)
|
Group B
(HTP)
(N=119)
|
Group C
(LTP)
(N=121)
|
Total
(N=714)
|
P
|
Underweight
<18.5
|
47
(43.2)
|
14
(10.8)
|
4
(11.0)
|
65
|
0.009*
|
Normal weight
18.5-24.9
|
321
(311.4)
|
72
(78.2)
|
76
(79.5)
|
469
|
|
Class I obesity(overweight)
25-29.9
|
92
(101.6)
|
30
(25.5)
|
31
(25.9)
|
153
|
|
Class II obesity(obesity)
30-39.9
|
14
(17.9)
|
3
(4.5)
|
10
(4.6)
|
27
|
|
Our previous studies showed that Group C (LTP) patients had the highest BMI, and meanwhile the supreme completely mature oocytes (CMO) rate. On the contrary, Group B(HTP) patients had the lowest BMI, and simultaneously the worst CMO rate. We proposed whether a lower BMI was accompanied by a worse CMO rate in different grouped specimens, and vice versa. Although no significant difference in CMO rate was observed among Group A, B, and C when stratified according to BMI (P=0.719, Table 4), CMO rate was the highest (72.31%) when BMI< 18.5 kg/m2 in all BMI categories. The highest rate of CMO in Group A(Concordant) was seen when BMI< 18.5 kg/m2 (72.34%), in Group B(HTP) when BMI≥ 25.0 kg/m2 (100%), and in Group C(LTP) when BMI 18.5-24.9 kg/m2 (81.58%).
Table 4 The ratio of completely mature oocytes in different groups sub-stratified according to BMI categories. P < 0.05 was considered statistically significant. Data were presented as n (%).
BMI classification
(kg/m2)
|
Group A
(Concordant)
(N=474)
|
Group B
(HTP)
(N=119)
|
Group C
(LTP)
(N=121)
|
Total
(N=714)
|
P
|
Underweight
<18.5
|
34/47
(72.34%)
|
11/14
(78.57%)
|
2/4
(50.00%)
|
47/65
(72.31%)
|
0.719
|
Normal weight
18.5-24.9
|
230/321
(71.65%)
|
41/72
(56.94%)
|
62/76
(81.58%)
|
332/469
(71.00%)
|
|
Class I obesity(overweight)
25-29.9
|
62/92
(67.39%)
|
19/30
(63.33%)
|
21/31
(67.74)
|
102/153
(66.67%)
|
|
Class II obesity(obesity)
30-39.9
|
7/14
(50.00%)
|
3/3
(100.00%)
|
8/10
(80.00%)
|
18/27
(66.67%)
|
|