title: Age as A Predictor of Embryo Quality Regardless of The Quantitative Ovarian Response.
abstract: BACKGROUND
  One determining factor of a successfulin vitrofertilization (IVF) cycle is embryo quality. The aim of the present study was to evaluate associations of embryo quality and reserve markers like age, FSH and AMH.
  
  
  METHODS
  In this prospective study, 120 infertile women, aged 21-44 years, undergoing routine exploration during an unstimulated cycle preceding assisted reproductive technology (ART) at our center were studied prospectively, from February 2011 to December 2014. Descriptive parameters and patient characteristics were reported as mean (SD) or median (range) depending on the distribution. Student's t test was performed for continuous variables, Wilcoxon and Pearson's Test were used for not distributed variables and Fisher's Test was performed for categorical variables. P<0.05 was considered statistically significant.
  
  
  RESULTS
  Overall, at the time of investigation, patients had a mean age of 33.03 ± 4.15 years old. On cycle day three, serum anti-Mullerian hormone (AMH) level was 3.50 ± 1.54 ng/mL, serum follicle-stimulating hormone (FSH) level was 6.29 ± 1.53 mUI/ mL, at baseline, women had 16.57 ± 7.0 antral follicles. The mean of collected oocytes was 11.80 ± 5.25, embryo I+II was 2.46 ± 2.11. A greater number of embryos I+II was observed in young patients. By evaluating 120 patients, a significant relationship was observed between age and FSH (r=0.24, P=0.01), age with AMH (r=-0.22, P=0.02), age with collected oocytes (r=-0.23, P=0.03) and age with embryo I+II (r=-0.22, P=0.03). A significant relationship was also observed between antral follicle count (AFC) and AMH (r=0.29, P=0.01), AFC and the number of transferred embryo (r=-0.18, P=0.03), AFC and total dose of the drugs (r=-0.23, P=0.03). Significant relationship of FSH with total dose of drugs (r=0.19, P=0.02) was also observed. In addition, we determined significant relationships between AMH and the number of collected oocytes (r=0.38, P=0.01), AMH and the number of metaphase II oocytes (r= 0.35, P=0.01), AMH and the number of embryo (r=0.19, P=0.04) as well as AMH and total dose of the drugs (r=-0.25, P=0.01).
  
  
  CONCLUSIONS
  Commonly used clinical markers of ovarian reserve are reflection of the ovarian reserve, while the outcome measurements of ART and age are the best predictors of embryo quality.
authors.affiliation: Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil.
authors.forename: Juliano Brum
authors.initials: JB
authors.lastname: Scheffer
authors.affiliation: Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil.
authors.forename: Bruno Brum
authors.initials: BB
authors.lastname: Scheffer
authors.affiliation: Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil.
authors.forename: Rafaela Friche
authors.initials: RF
authors.lastname: de Carvalho
authors.affiliation: Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil.
authors.forename: Joyce
authors.initials: J
authors.lastname: Rodrigues
authors.affiliation: Department of Reproductive Medicine, Hospital Jean Verdier (AP-HP), University Paris XIII, and INSERM, Paris, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Grynberg
authors.affiliation: School of Medicine, Tecnológico de Monterrey and Center for Reproductive Medicine CREASIS San Pedro Monterrey, México.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Mendez Lozano
keywords: Age; Anti-Mullerian Hormone; Follicle-Stimulating Hormone