P-636 Prospective observational study on the influence of anti-Müllerian hormone (AMH) levels and body mass index on the success rate of intra-uterine inseminations in infertile patients
Notice bibliographique
Résumé
Abstract Study question Determine the clinical relevance of AMH to predict chances of live birth in patients undergoing intra-uterine inseminations (IUI) treatments with oral controlled ovarian stimulation (COS) Summary answer AMH level is a predictor of live birth in patients undergoing IUI. AMH level ≥ 23,7 pmol/L was linked to a higher live birth rate. What is known already The AMH, a glycoprotein produced by the granulosa cells of the antral and pre-antral follicles, reflects the quantity of these follicles present in the ovaries. It is therefore a serum marker of ovarian reserve. AMH levels decrease continuously with advancing age. There is little variability during the menstrual cycle, which makes it an interesting marker. Commonly used in in-vitro fertilization (IVF) to predict a weak or an exaggerated response to ovarian stimulation, AMH makes it possible to predict the number of oocytes retrieved. Study design, size, duration This is a prospective observational study that took place between June 2017 and December 2021 at University Hospital Center – Université Laval (CHUL), a center in which approximately 2,000 inseminations per year are performed. Three hundred and twelve patients were recruited for this study. However, 91 patients were excluded because they did not complete 3 IUI cycles. Some had spontaneous pregnancies, others proceeded with IVF and others simply decided to abandon the fertility procedures. Participants/materials, setting, methods The patients included were between 18 and 40 years old and had a diagnosis of primary/secondary infertility (endometriosis, mild male factor or unexplained). They received IUI treatments with oral COS. The patients had to complete 3 insemination cycles or obtain a pregnancy during one of these cycles. The following information was retrieved : age, ethnicity, BMI, parity/gravity, duration/cause of infertility, AMH level, AFC, FSH level and outcome of each insemination. Main results and the role of chance Of the 221 patients, 74 achieved clinical pregnancy and 56 had live births. The average age of study participants was 32.5 years. The mean BMI was 26. The average AMH level was 24.8 pmol/L. The main diagnosis of infertility was a male factor. The group of patients who had a live birth was compared to the group without a live birth regarding age, BMI, AMH, FSH and AFC. No significant differences were found in the two groups in term of age, BMI, FSH and AFC. However, the AMH level was higher in patients who achieved a live birth (31,3 pmol/L (1,4-186,0)) compared to patients who did not get pregnant (17,5 pmol/L (0-110,6)) (OR 1.13 (1.02;1.24)). To identify a good prognosis AMH threshold, a calculation was made. There is a significant increase in the number of live births when the AMH is equal to or greater than 23,7 pmol/L (OR 2.48 IC 1.33; 4.61, p = 0.004). Over this threshold, we observe 36.5% of live births, while below this threshold the rate is 18.8%. If we observe the ROC curve of AMH as a predictor of live births, we obtain an AUC of 0.59 which is significant (CI = 0.50; 0.68). Limitations, reasons for caution A limitation of our study was the large number of patients lost to follow-up during our study. Indeed, 90 patients recruited did not receive 3 cycles of insemination and did not develop a pregnancy (reference to IVF or COS with gonadotropins, spontaneous pregnancy or abandon). Wider implications of the findings AMH level, and more precisely a level of 23,7 pmol/L or more, could be a useful predictor for obtaining a live birth in the context of a fertility treatment including IUI with COS by oral medication. Trial registration number No
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».