Optimal anti-müllerian hormone level in oocyte donors: a national database analysis

Anti-Müllerian hormone (AMH) is an excellent predictor of ovarian response and oocyte yield after ovarian stimulation [1]. While a good response to stimulation is valuable for donor selection, from a recipient perspective, the most important outcomes include the number of usable embryos that develop and the pregnancy outcome per transfer. The association between high AMH and pregnancy outcomes in autologous IVF population is conflicting and relatively unexplored in donor oocyte-recipient cycles. Our objective was to evaluate the relationship between high AMH level in oocyte donors and the embryo development and pregnancy outcomes for the donor oocyte recipients. Retrospective cohort study of oocyte-donor recipient cycles at Donor egg bank USA between 2013-2021. Only the first oocyte thaw with intended embryo transfer from each donor cycle was included. Primary outcome: Ongoing pregnancy rates (OPR), viable intrauterine pregnancy around 8 weeks of gestation, and embryo development outcomes among vitrified donor-oocyte recipients. Secondary outcome: Embryo ploidy and pregnancy outcomes among recipients that utilized preimplantation genetic testing for aneuploidy (PGT-A). Based on donor AMH serum concentration, cycles were stratified into (1) high AMH group (AMH >=5 ng/mL; n=1,821), and (2) referent group (AMH <5ng/mL; n=2,050), based on previous data from autologous cycles [2]. Modified Poisson regression was used to calculate the RR and 95% CI. In secondary analysis, AMH was analyzed as a continuous variable. The median (IQR) number of usable embryos was significantly increased in the high AMH group [2 (2-4)] compared to the referent group [2 (1-3)] [RR 1.06; CI 1.01-1.12]. Each 1-unit increase in donor AMH level was associated with a 1% increase in the number of usable embryos available [RR 1.01; 95 % CI 1.01-1.02]. Among recipients with a planned embryo transfer, there was no difference in OPR between the high AMH group (45.4%) and the referent group (43.5%) [RR 1.04; 95 % CI 0.94-1.15]. Embryo biopsy for preimplantation genetic testing for aneuploidy (PGT-A) was performed in 14.4% of cycles. Among PGT-A cycles, embryo euploidy rate was similar at 66.7% (50-100%) in the high AMH group and 66.7% (50-100%) in the referent group [RR 1.04; CI 0.92-1.17]. OPR among patients who utilized PGT-A was also similar at 47.3% in the high AMH group and 47.8% in the referent group [RR 0.98; CI 0.77-1.27]. No association was observed between a high AMH (>=5 ng/mL) in oocyte donors and ongoing pregnancy rates in the recipient after first planned embryo transfer. However, donors with high AMH (>=5 ng/mL) had a significantly higher number of usable embryos develop than those with AMH <5 ng/mL, despite a comparable number of oocytes per lot.