Toward a better understanding of functional ovarian reserve: AMH (AMHo) and FSH (FSHo) hormone ratios per retrieved oocyte.

CONTEXT: Functional ovarian reserve (FOR) has recently been demonstrated to differ with ovarian genotypes of the FMR1 gene and is currently routinely determined with anti-Müllerian hormone (AMH) and FSH. Both, however, reflect distinctively different stages of folliculogenesis.
OBJECTIVES: To better understand how AMH and FSH reflect FOR, we evaluated both hormones in association with in vitro fertilization (IVF) by determining how they associate with oocyte yields, considered the most accurate available measure of FOR. DESIGN AND
SETTING: Using a series of logistic regressions, we assessed AMH and FSH per oocyte retrieved (AMHo and FSHo) in only first IVF cycles and determined whether at different ages and/or based on ovarian FMR1 genotypes and subgenotypes AMHo and/or FSHo are associated with clinical pregnancy chances in IVF. PATIENTS: We investigated 392 consecutive IVF patients of all ages, with among them 60.7% suffering from diminished FOR.
INTERVENTIONS: Interventions included routine IVF cycles. MAIN OUTCOME MEASURE: Clinical pregnancy rate in IVF cycle was assessed.
RESULTS: FSHo, but not AMHo, was, overall, statistically associated with pregnancy chances in IVF. This association was further limited to women above age 38 yr. FSHo was also significantly associated with pregnancy chances in women with normal FMR1 genotype, although only almost reaching significance with heterozygous-normal/low. Normal-genotype patients also demonstrate significant interaction between FSHo and age in pregnancy outcome, although insignificant for all other FMR1 genotypes and subgenotypes and universally for AMHo.
CONCLUSIONS: AMHo and FSHo are representative of distinctively different components of FOR, likely influenced by different ovarian FMR1 genotypes and subgenotypes.