Anti-Mullerian hormone concentrations in the follicular fluid of the preovulatory follicle are predictive of the implantation potential of the ensuing embryo obtained by in vitro fertilization

Context: The strong relationship between serum anti-Mullerian hormone ( AMH) levels and the number of antral follicles supports the use of AMH measurements as a quantitative marker of the ovarian follicular status. Yet, it still is unclear whether the aptitude of an individual follicle to produce AMH reflects its reproductive competence. Objective: This study examined the possible relationship between serum or follicular fluid ( FF) AMH concentrations and the fate of the ensuing oocytes and embryos obtained by in vitro fertilization-embryo transfer conducted in monodominant follicle cycles. Design and Setting: We conducted a prospective study at the University of Paris XI, Assistance Publique-Hopitaux de Paris, Institut National de la Sante et de la Recherche Medicale U782. Patients: Patients included 118 infertile in vitro fertilization-embryo transfer candidates. Interventions: Concentrations of AMH, progesterone, and estradiol were measured in the serum on cycle d 3 and on the day of oocyte pickup ( dOPU), and in FF. Cycles were sorted into three sets of three distinct groups according to whether serum d 3, serum dOPU, and FF AMH concentrations were 30th centile or below ( low AMH), between the 31st and the 70th centiles ( average AMH), or above the 70th centile ( high AMH) of measurements. Main Outcome Measure: Clinical pregnancy and embryo implantation rates were assessed. Results: Clinical pregnancy rates ( 5.7, 20.0, and 39.5%, respectively; P < 0.002) and embryo implantation rates ( 11.8, 30.8, and 65.4, respectively; P < 0.001) were markedly different among the low, moderate, and high FF AMH groups but not among the serum ( d 3 or dOPU) AMH groups. Fertilization rates and embryo morphology remained similar irrespective of AMH concentrations in the serum or in FF. Incidentally, FF AMH concentrations were negatively correlated with FF progesterone ( r = -0.27; P < 0.003) and FF estradiol ( r = -0.21; P < 0.02) concentrations. Conclusions: Concentrations of AMH in the FF, but not in the serum, constitute a useful follicular marker of embryo implantation and are negatively related to FF progesterone and estradiol concentrations.