title: Mullerian inhibiting substance levels at the time of HCG administration in IVF cycles predict both ovarian reserve and embryo morphology.
abstract: BACKGROUND
  Pre-antral and early antral follicles secrete Müllerian inhibiting substance (MIS), suggesting that MIS may directly reflect ovarian reserve. Since little is known about how ovarian reserve affects oocyte quality, we attempt here to assess the predictive value of MIS on embryo morphology and IVF outcome. To do so, we measured MIS at the time of HCG administration 36 h prior to oocyte retrieval.
  
  
  METHODS
  A total of 257 patients undergoing IVF were prospectively recruited. We measured MIS levels by enzyme-linked immunosorbent assay at the time of HCG, and compared the MIS values to day 3 FSH levels in the prediction of embryo morphology and IVF outcome.
  
  
  RESULTS
  The distribution of MIS levels was skewed, with a median of 2.7 ng/ml (range 0 to 28.5 ng/ml). MIS values at the time of HCG administration inversely correlated with basal FSH levels (P = 0.002), and both correlated significantly with patient age, number of mature follicles, number of oocytes retrieved and serum estradiol levels. MIS levels correlated significantly with a greater number of 6-cell embryos and better embryo morphology score, while basal FSH levels did not correlate with these outcome variables. MIS levels > or =2.7 ng/ml portended improved oocyte quality as reflected in a higher implantation rate (P = 0.001) and a trend toward a better clinical pregnancy rate (P = 0.084).
  
  
  CONCLUSIONS
  MIS levels seem to predict not only ovarian reserve, but also embryo morphology. Measurement of MIS at the time of HCG administration may, therefore, in the future improve management of patients undergoing treatments with assisted reproductive technology.
authors.affiliation: Women and Infants' Hospital of Rhode Island, Brown University Division of Biology and Medicine, Providence, Rhode Island 02905, USA.
authors.forename: T
authors.initials: T
authors.lastname: Silberstein
authors.forename: D T
authors.initials: DT
authors.lastname: MacLaughlin
authors.forename: I
authors.initials: I
authors.lastname: Shai
authors.forename: J R
authors.initials: JR
authors.lastname: Trimarchi
authors.forename: G
authors.initials: G
authors.lastname: Lambert-Messerlian
authors.forename: D B
authors.initials: DB
authors.lastname: Seifer
authors.forename: D L
authors.initials: DL
authors.lastname: Keefe
authors.forename: A S
authors.initials: AS
authors.lastname: Blazar
mesh_terms: D054304:Anti-Mullerian Hormone; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D004622:Embryo, Mammalian / Q000166:cytology*; D005260:Female; D005307:Fertilization in Vitro; D006023:Glycoproteins / Q000032:analysis*; D006801:Humans; D010053:Ovary / Q000737:chemistry*; D011379:Prognosis; D013735:Testicular Hormones / Q000032:analysis*; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D006023:Glycoproteins; D013735:Testicular Hormones; D054304:Anti-Mullerian Hormone