The effect of age and AMH level on ART outcomes in patients with reduced ovarian reserve: A retrospective  cross-sectional study

Background Despite many advances, patients with a poor ovarian response to stimulation are one of the most important and challenging factors of infertility. Chronological and ovarian ages are two effective factors in poor response to assisted reproductive treatment. The purpose of this study was to determine the effect of age and AMH level on the In vitro fertilization (IVF) outcomes in participants with a reduced ovarian reserve.

Methods In this retrospective cross-sectional study, 210 participants with anti-Mullerian hormone (AMH) <1.1ng/ml were included. The effect of age and AMH on pregnancy outcomes including dominant follicle count, serum estradiol level on the  day of trigger administration, number of metaphase II (MII) oocytes, number of embryos, biochemical pregnancy, clinical pregnancy, abortion and live birth rate were evaluated.

Results The number of dominant follicle (p<0.001), MII oocyte (p<0.001), grade A (p<0.001) and B (p<0.001) embryos, serum estradiol level (p<0.001), gonadotropin level (p<0.001), AMH (p=0.001), biochemical (p=0.007) and clinical (p=0.01) pregnancy, and live birth rate (p=0.003) were higher in participants younger than 35 years old. In univariable logistic regression, the chance of retrieving more than 3 oocytes in individuals over 35 years old was 97.1% lower than in individuals younger than 35 years old (p<.001).

Conclusion It has been concluded that the higher clinical pregnancy and live birth rate in participants younger than 35 years can be due to the higher AMH level in this group. Also, under the same conditions of AMH and other variables, age can affect the number of retrieved oocytes.