Online first

Demographic characteristics and AMH levels in rural and urban women participating in an IVF programme

Michał Kunicki 1, 2,  
Krzysztof Łukaszuk 1, 3, 2,  
Joanna Liss 1, 3,  
Grzegorz Jakiel 1, 4,  
INVICTA Fertility and Reproductive Center, Warsaw, Poland
Department of Gynecological Endocrinology, Medical University of Warsaw, Poland
INVICTA Fertility and Reproductive Center, Gdańsk, Poland
Department of Obstetrics and Gynaecology, Medical Center of Postgraduate Education, Warsaw, Poland
Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Poland
The primary aim of this preliminary study was to compare the IVF results of couples living in rural and urban areas. Additionally, the ovarian reserve parameters, such as AMH concentrations, were compared for the same groups.

Material and Methods:
The database of 1,265 women undergoing in vitro fertilization at the Invicta Fertility Center between May 2011-July 2012 were retrospectively analyzed. Women undergoing their first assisted reproductive technology cycle with ICSI, stimulated according to the long protocol, and whose AMH levels were measured using the same DSL kit, were selected. Ultimately, 651 women were included in the study. All participants were categorized based on the area where they live: rural areas, small towns (<100,000 inhabitants) and large cities (>100,000).

The mean age of the patients living in large cities was significantly higher in comparison to those from rural areas and small towns. A significantly higher pregnancy body mass index (BMI) was found in women from rural areas in comparison to the women living in small and large towns. Serum AMH and inhibin B concentrations, number of ampules of gonadotropins, and antral follicle count (AFC), did not differ significantly among the groups. The study showed no significant differences among the groups in terms of clinical pregnancy rate, both per started cycle and per embryo transfer.

No significant differences were found in IVF outcomes among the groups inhabiting rural areas, small and large cities.

1. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006; 12(6): 685–718.
2. La Marca A, Nelson SM, Sighinolfi G, Manno M, Baraldi E, Roli L, et al. Anti-Müllerian hormone-based prediction model for a live birth in assisted reproduction. Reprod Biomed Online. 2011; 22(4): 341–9.
3. Cai QF, Wan F, Huang R, Zhang HW. Factors predicting the cumulative outcome of IVF/ICSI treatment: a multivariable analysis of 2450 patients. Hum Reprod. 2011; 26(9): 2532–40.
4. Hourvitz A, Lerner-Geva L, Elizur SE, Baum M, Levron J, David B, et al. Role of embryo quality in predicting early pregnancy loss following assisted reproductive technology. Reprod Biomed Online. 2006; 13(4): 504–9.
5. Bancsi LFJMM, Broekmans FJM, Eijkemans MJC, de Jong FH, Habbema JDF, te Velde ER. Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve. Fertil Steril. 2002; 77(2): 328–36.
6. Verberg MFG, Eijkemans MJC, Macklon NS, Heijnen EMEW, Fauser BCJM, Broekmans FJ. Predictors of ongoing pregnancy after single-embryo transfer following mild ovarian stimulation for IVF. Fertil Steril. 2008; 89(5): 1159–65.
7. Te Velde ER, Nieboer D, Lintsen AM, Braat DDM, Eijkemans MJC, Habbema JDF, et al. Comparison of two models predicting IVF success; the effect of time trends on model performance. Hum Reprod. 2014; 29(1): 57–64.
8. Younglai EV, Holloway AC, Foster WG. Environmental and occupational factors affecting fertility and IVF success. Hum Reprod Update. 2005; 11(1): 43–57.
9. ESHRE Task Force on Ethics and Law, including, Dondorp W, de Wert G, Pennings G, Shenfield F, Devroey P, et al. Lifestyle-related factors and access to medically assisted reproduction. Hum Reprod Oxf Engl. 2010; 25(3): 578–83.
10. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod Oxf Engl. 2007; 22(6): 1506–12.
11. Jain T, Hornstein MD. Disparities in access to infertility services in a state with mandated insurance coverage. Fertil Steril. 2005; 84(1): 221–3.
12. Kessler LM, Craig BM, Plosker SM, Reed DR, Quinn GP. Infertility evaluation and treatment among women in the United States. Fertil Steril. 2013; 100(4): 1025–1032.e2.
13. Homan GF, Davies M, Norman R. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Hum Reprod Update. 2007; 13(3): 209–23.
14. Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online. 2011; 23(4): 421–39.
15. Klonoff-Cohen H, Natarajan L, Marrs R, Yee B. Effects of female and male smoking on success rates of IVF and gamete intra-Fallopian transfer. Hum Reprod Oxf Engl. 2001 Jul;16(7):1382–90.
16. Florack EI, Zielhuis GA, Rolland R. Cigarette smoking, alcohol consumption, and caffeine intake and fecundability. Prev Med. 1994 Mar;23(2):175–80.
17. Kim D, Bloom MS, Parsons PJ, Fitzgerald EF, Bell EM, Steuerwald AJ, et al. A pilot study of seafood consumption and exposure to mercury, lead, cadmium and arsenic among infertile couples undergoing in vitro fertilization (IVF). Environ Toxicol Pharmacol. 2013; 36(1): 30–4.
18. Snijder CA, te Velde E, Roeleveld N, Burdorf A. Occupational exposure to chemical substances and time to pregnancy: a systematic review. Hum Reprod Update. 2012; 18(3): 284–300.
19. Figà-Talamanca I, Traina ME, Urbani E. Occupational exposures to metals, solvents and pesticides: recent evidence on male reproductive effects and biological markers. Occup Med Oxf Engl. 2001; 51(3): 174–88.
20. Milewski R, Milewska AJ, Czerniecki J, Leśniewska M, Wołczyński S. [Analysis of the demographic profile of patients treated for infertility using assisted reproductive techniques in 2005–2010]. Ginekol Pol. 2013; 84(7): 609–14.
21. Mac Dougall K, Beyene Y, Nachtigall RD. Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Hum Reprod Oxf Engl. 2013; 28(2): 350–6.
22. Carpenter DO, Shen Y, Nguyen T, Le L, Lininger LL. Incidence of endocrine disease among residents of New York areas of concern. Environ Health Perspect. 2001;109 Suppl 6: 845–51.
23. Juul S, Karmaus W, Olsen J. Regional differences in waiting time to pregnancy: pregnancy-based surveys from Denmark, France, Germany, Italy and Sweden. The European Infertility and Subfecundity Study Group. Hum Reprod Oxf Engl. 1999; 14(5): 1250–4.
24. Runge A. Medium-sized towns in the context of size structural changes of towns in Poland. Medium sized towns of Central-Eastern Europe in the period ofeconomic system transformation and social changes, National Academy of Public Administrationat the President of Ukraine, Kharkiv Regional Institute of Public Administration. 2011th ed. Kharkiv: Publishing House “ADNDU”; p. 66–87.
25. Huang JYJ, Rosenwaks Z. In vitro fertilisation treatment and factors affecting success. Best Pract Res Clin Obstet Gynaecol. 2012; 26(6): 777–88.
26. Farland LV, Missmer SA, Rich-Edwards J, Chavarro JE, Barbieri RL, Grodstein F. Use of fertility treatment modalities in a large United States cohort of professional women. Fertil Steril. 2014; 101(6): 1705–10.
27. Jain T, Harlow BL, Hornstein MD. Insurance coverage and outcomes of in vitro fertilization. N Engl J Med. 2002; 347(9): 661–6.
28. Bhattacharya S, Porter M, Amalraj E, Templeton A, Hamilton M, Lee AJ, et al. The epidemiology of infertility in the North East of Scotland. Hum Reprod Oxf Engl. 2009; 24(12): 3096–107.
29. Łepecka-Klusek C, Wdowiak A, Pilewska-Kozak AB, Syty K, Jakiel G. The role of age, environmental and occupational factors on semen density. Ann Agric Environ Med AAEM. 2011; 18(2): 437–40.
30. Klonoff-Cohen H. Female and male lifestyle habits and IVF: what is known and unknown. Hum Reprod Update. 2005; 11(2): 179–203.
31. Sołtysiak E. [The influence of socioeconomic factors on female fertility]. Ginekol Pol. 2005; 76(12): 986–90.
32. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. Low N, editor. PLoS Med. 2012; 9(12):e1001356.
33. Jain T. Socioeconomic and racial disparities among infertility patients seeking care. Fertil Steril. 2006; 85(4): 876–81.
34. Wdowiak A, Lewicka M, Plewka K, et al. Nicotinism and quality of embryos obtained in in-vitro fertilization programmes. Ann Agric Environ Med. 2013; 20(1): 82–85.
35. Cinar O, Dilbaz S, Terzioglu F, Karahalil B, Yücel C, Turk R, et al. Does cigarette smoking really have detrimental effects on outcomes of IVF? Eur J Obstet Gynecol Reprod Biol. 2014;174:106–10.
36. Weigert M, Hofstetter G, Kaipl D, Gottlich H, Krischker U, Bichler K, et al. The effect of smoking on oocyte quality and hormonal parameters of patients undergoing in vitro fertilization-embryo transfer. J Assist Reprod Genet. 1999; 16(6): 287–93.
37. Fréour T, Dessolle L, Lammers J, Lattes S, Barrière P. Comparison of embryo morphokinetics after in vitro fertilization-intracytoplasmic sperm injection in smoking and nonsmoking women. Fertil Steril. 2013; 99(7): 1944–50.
38. Sterzik K, Strehler E, De Santo M, Trumpp N, Abt M, Rosenbusch B, et al. Influence of smoking on fertility in women attending an in vitro fertilization program. Fertil Steril. 1996; 65(4): 810–4.
39. Bellver J, Ayllón Y, Ferrando M, Melo M, Goyri E, Pellicer A, et al. Female obesity impairs in vitro fertilization outcome without affecting embryo quality. Fertil Steril. 2010; 93(2): 447–54.
40. Jungheim ES, Schon SB, Schulte MB, DeUgarte DA, Fowler SA, Tuuli MG. IVF outcomes in obese donor oocyte recipients: a systematic review and meta-analysis. Hum Reprod Oxf Engl. 2013; 28(10): 2720–7.
41. Caillon H, Fréour T, Bach-Ngohou K, Colombel A, Denis MG, Barrière P, et al. Effects of female increased body mass index on in vitro fertilization cycles outcome. Obes Res Clin Pract. 2015.
42. Schliep KC, Mumford SL, Ahrens KA, Hotaling JM, Carrell DT, Link M, et al. Effect of male and female body mass index on pregnancy and live birth success after in vitro fertilization. Fertil Steril. 2015; 103(2): 388–95.
43. Strohmer H, Boldizsar A, Plöckinger B, Feldner-Busztin M, Feichtinger W. Agricultural work and male infertility. Am J Ind Med. 1993; 24(5): 587–92.
44. Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, et al. The physiology and clinical utility of anti-Mullerian hormone in women. Hum Reprod Update. 2014; 20(3): 370–85.
45. Iliodromiti S, Kelsey TW, Wu O, Anderson RA, Nelson SM. The predictive accuracy of anti-Müllerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature. Hum Reprod Update. 2014; 20(4): 560–70.