Explorative biochemische Analyse aktueller Biomarker in humaner Follikelflüssigkeit und deren Einfluss auf das Vorhandensein einer Eizelle, den follikulären Durchmesser, das Eintreten einer klinischen Schwangerschaft etc. in der assistierten Reproduktion, basierend auf dem Anti-Müller-Hormon

The main questions to be answered by this work were related to the relationship of follicular anti-Müllerian hormone (AMH) with follicular diameter, the presence of an oocyte and other hormones and vitamins. In the long term, this should make it possible to gain new insights that can contribute to a better understanding of oocyte maturation, etc. Previous research on follicular AMH (fAMH) has already provided evidence that there is a relationship between fAMH and follicular diameter or the presence of an oocyte (see, for example, Desforges-Bullet et al. 2010, Kedem et al. 2013, Mamsen et al. 2021). However, this has only ever been done on the basis of small numbers of cases, by studying cryopreserved follicles or follicles obtained by in vitro maturation (IVM), or by comparison with a dominant follicle. In this work, based on a large data set, it was possible to examine the follicular fluid of a majority of follicles of the respective patients without changing the normal course of ART. In conclusion, there is a significant negative correlation between follicular diameter and fAMH (1 ng/ml less the larger the diameter, p < 0.001). It can be inferred that granulosa cells of large follicles do not necessarily produce more AMH than small follicles. Accordingly, small follicles contain a significantly higher concentration of AMH than large follicles. In relation to the presence of an oocyte, the presence of an oocyte was shown to be significantly associated with AMH levels (mean average 2.1 ng/ml, p < 0.001). High follicular AMH levels may be more likely to be measured in follicles that have an oocyte. Furthermore, new insights were gained and previously existing knowledge between fAMH, steroid hormones, vitamin D, socioeconomic parameters and various treatment variables was consolidated. It was found that there was a weak but significant negative association between fAMH and patient age (r = -0.11, p < 0.001). This means that the follicles of older patients have lower fAMH levels than those of younger patients. Only a minimally significant positive correlation was established between fAMH and patient body mass index (BMI) (r = 0.03, p < 0.006). A negative correlation was found between fAMH and vitamin D (r = -0.13, p < 0.001) or progesterone (r = -0.21, p < 0.001). In contrast, fAMH and luteinizing hormone (LH) were shown to have a significant positive correlation (r = 0.35, p < 0.001). This work made it possible to reflect a holistic picture of the follicles, since almost all follicles of each patient were included in the evaluation. Therefore, for the first time, each follicle could be examined individually and comparably for the above-mentioned parameters. Until now, the available results only reflected partial aspects of ART (cryopreservation, IVM, single follicle, dominant follicle, etc.). Accordingly, the basically applicable "Standard Operating Procedures" (SOPs) were not changed for this work. The findings thus gained provides basic information on the role of AMH in ART, especially in relation to follicular fluid. This can add to the current state of science on this topic. Thus, this knowledge may be useful for future development and improvement of reproductive medicine. Further research, e.g. on the effect of AMH on fertilization rate and oocyte development, is necessary to further improve assisted reproductive technology in the future.