The Intertwined and Independent Predictive Roles of Maternal Age, Anti-Müllerian Hormone (AMH), and Oocyte Quantity during In Vitro Fertilization (IVF) Restricted; Files Only

Meyer, Fiona (Spring 2025)

Permanent URL: https://etd.library.emory.edu/concern/etds/dr26z0098?locale=it
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Abstract

Infertility is a widespread problem in the U.S., and given age-related declines in fertility and the rising average age of American mothers, fertility challenges and the associated need for fertility treatments have grown increasingly prevalent. This thesis aims to improve our understanding of the deeply intertwined relationship between aging and fertility treatment outcomes through an evaluation of the age-dependent and independent predictive abilities of anti-müllerian hormone (AMH), a key biomarker of reproductive aging and ovarian reserve, during in vitro fertilization (IVF) treatment. Results from 454 IVF cycles reveal AMH’s limitations for predicting indirect indicators of oocyte quality, including fertilization and aneuploidy rate, as well as cycle outcomes, such as clinical pregnancy. Simultaneously, these findings highlight AMH's age-associated and age-independent validity for predicting oocyte quantity. Modeled linearly, AMH levels offered a strong prediction of total oocyte quantity at retrieval (t = 15.2, p = 2.57E-42), and while maternal age partially mediated this association (z = 2.83, 95% CI: 0.01-0.14, p = 0.02), AMH remained a strong indicator of oocyte quantity independently of maternal age (t = 14.6, p = 8.54E-40). These findings were strengthened by the calculation of age-adjusted AMH scores, which were significantly associated with oocyte quantity (t = 10.5, p = 4.73E-23). Additionally, these results also highlight the validity of age-adjusted oocyte quantity scores for predicting subsequent clinical pregnancy (z = 3.227, p = 1.25E-03). In conclusion, these findings suggest the age-associated and age-independent predictive validity of AMH for ovarian reserve and response, and in turn, of total oocyte quantity for clinical pregnancy. Further, these data highlight the importance of distinguishing between normal and abnormal changes in AMH levels during aging, furthering our understanding of reproductive aging as it relates to IVF success.

Table of Contents

1.INTRODUCTION ... 1

1.1: BACKGROUND AND MOTIVATION ... 1

1.2: OBJECTIVES AND SIGNIFICANCE ... 2

1.3: MATERIALS AND METHODS ... 3

1.3.1: Study Participants ... 3

1.3.2: Defining Diminished Ovarian Reserve (DOR) ... 4

1.3.3: Statistical Analyses ... 4

1.3.4: Methods ... 4

2. RESULTS ... 7

2.1: PRELIMINARY ANALYSES ... 7

2.2: AMH PREDICTS OOCYTE QUANTITY, BUT NOT INDICATORS OF OOCYTE QUALITY ... 8

2.3: MATERNAL AGE PREDICTS OOCYTE QUANTITY AND ANEUPLOIDY, BUT NOT FERTILIZATION AND BLASTULATION ... 9

2.4: MATERNAL AGE PARTIALLY MEDIATES AMH’S PREDICTION OF OOCYTE QUANTITY AT RETRIEVAL ... 10

2.5: AMH PREDICTS OOCYTE QUANTITY, WHEN ADJUSTING FOR MATERNAL AGE ... 11

2.6: AMH FAILS TO PREDICT CLINICAL PREGNANCY, WHILE OOCYTE QUANTITY OFFERS AGE-ASSOCIATED AND AGE-ADJUSTED PREDICTIONS OF CLINICAL PREGNANCY ... 12

3. CONCLUSION ... 15

3.1: DISCUSSION ... 15

3.2: ANTHROPOLOGICAL SIGNIFICANCE ... 16

3.3: LIMITATIONS AND FUTURE DIRECTIONS ... 18

4. WORKS CITED ... 23

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