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Anti-Müllerian hormone in guiding the selection of a freeze-all versus a fresh embryo transfer strategy: a cohort study

  • Assisted Reproduction Technologies
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Abstract

Purpose

To explore an interaction effect between serum anti-Müllerian hormone (AMH) levels and the relative treatment effect of a freeze-all versus a fresh embryo transfer strategy on live birth.

Methods

This was a retrospective cohort study investigating couples with infertility and eligible for both freeze-all and fresh embryo transfer between 2017 and 2019. Women with an absolute indication for a freeze-all strategy were excluded. Multivariable fractional polynomial interaction analysis within a logistic regression model was used to evaluate whether the treatment effect of a freeze-all versus a fresh transfer strategy varied at different AMH levels. Non-linear interactions were also considered. The primary outcome was the live birth after the first transfer.

Results

A total of 13,503 women underwent a fresh embryo transfer and 2247 women underwent a freeze-all strategy. Live birth rates were slightly higher in the freeze-all group compared to those in the fresh embryo transfer group (35% vs 33%). There was a non-linear interaction between baseline serum AMH levels and the relative treatment effect of a freeze-all strategy versus a fresh transfer strategy on live birth (P = 0.0161). The benefit on live birth from a freeze-all embryo transfer strategy was greatest in women with a high serum level (> 7 ng/ml). The interaction remained valid when different imputation methods were used.

Conclusion

As serum AMH level increased, there was a nonlinear increase in relative treatment effect of a freeze-only transfer versus a fresh transfer strategy on live birth, and such an effect reaches its maximum in women with high AMH levels.

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Acknowledgements

We thank Lixue Chen in Peking University Third Hospital for helping us to collect the data.

Funding

This study was supported by the National Science Fund for Distinguished Young Scholars (Rong Li, Grant No. 81925013) and National Key Research and Development Program of China (Rong Li, Grant No. 2018YFC1004100). RW is supported by an NHMRC Emerging Leadership Investigator Grant (2009767).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China

    Kai-Lun Hu, Rui Yang, Huiyu Xu & Rong Li

  2. Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia

    Ben W. Mol & Rui Wang

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  1. Kai-Lun Hu
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Contributions

KL.H, RL, and RW conceived and design the study; KL.H and RW conducted the analysis and designed the figures and tables; KL.H reviewed the literature and wrote the first draft; KL.H, RW, and BWM revised the manuscript. All authors participated in the discussion of analysis and interpretation of data in this article.

Corresponding author

Correspondence to Rong Li.

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Ethics approval

Institutional Review Board (IRB) approval for this retrospective cohort study was obtained from the Ethics Committee of Peking University Third Hospital (reference: 2018S2-002).

Competing interests

BWM is supported by a NHMRC Investigator grant (GNT1176437), and BWM reports consultancy for ObsEva, Merck Merck KGaA, iGenomix, and Guerbet. The other authors have no conflict of interest to declare.

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Kai-Lun Hu and Rui Yang are joint first authors.

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Hu, KL., Yang, R., Xu, H. et al. Anti-Müllerian hormone in guiding the selection of a freeze-all versus a fresh embryo transfer strategy: a cohort study. J Assist Reprod Genet 39, 2325–2333 (2022). https://doi.org/10.1007/s10815-022-02564-3

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