抗苗勒管激素与卵巢反应性及妊娠结局的相关研究
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摘要
目的：探讨IVF-ET药物刺激卵巢过程中不同时期的抗苗勒管激素(anti-Mu llerian hormone, AMH)水平对预测卵巢反应性及妊娠结局的意义。
方法：选择60例行IVF-ET治疗的患者,于月经第2-4天采用酶联荧光法测定基础血清卵泡刺激素(follicle stimulating hormone, FSH)、促黄体生成素(luteinizing hormone, LH)、雌二醇(estradiol, E2),同时应用超声行卵巢窦卵泡计数(antral follicle count, AFC)。于月经第2-4天、促性腺素刺激卵巢第5日、注射hCG日采用酶联免疫吸附法(ELISA)测定血清AMH水平；记录年龄、体重指数(BMI)、获卵数、成熟卵子数、优质胚胎数等。反应性以获卵数分组,获卵数≤5枚为低反应组,>5枚为正常反应组,出现卵巢过度刺激(OHSS)的为OHSS组；妊娠结局以是否怀孕分组,分为临床妊娠组及未妊娠组。应用SPSS11.5软件的相关统计方法对上述各分组间的相应指标进行分析比较。
结果：(1)低反应组与正常反应组及OHSS组相比其基础日、Gn刺激第5日及hCG日的血清AMH均明显降低,差异有统计学意义(p＜0.05); OHSS组与正常反应组相比其基础日、Gn刺激第5日及hCG日的血清AMH均明显升高,差异有统计学意义(p<0.05)；(2)妊娠组与未妊娠组相比,基础日、Gn第5日及hCG日血清AMH水平均无统计学差异(p＞0.05)；(3)基础日、Gn第5日及hCG日血清AMH预测卵巢低反应性ROC曲线下面积(ROCA(?)C)分别为0.923,0.932,0.934。
结论：(1))在IVF过程中各阶段的血清AMH水平与目前临床常用指标相比,对卵巢反应性预测诊断价值相对较高、较灵敏。(2)IVF过程中各阶段的AMH均无法预测妊娠结局。(3)若基础日、Gn第5日及hCG日的AMH水平分别以Cut-off值为1.72ng/ml、0.87 ng/ml、0.28 ng/ml作为判断标准的话,其预测低反应性的敏感性及特异性均可达80%左右。
Objective:To explore the predictive value of anti-Mullerian hormone (AMH/MIS) level during different phases of in vitro fertilization and embryo transfer (IVF-ET) treatment cycle on ovarian response and clinical-pregnancy outcome.
Methods:A total of 60 patients undergoing IVF was prospectively recruited. On day 2-4 of the menstrual cycle, levels of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) were measured by enzyme-linked fluorescent assay. Serum AMH levels were measured on day 2～4 of the menstrual cycle, day 5 gonadotropin (Gn)administration and hCG administration by enzyme-linked immunosorbent assay (ELISA); and ultrasound evaluation of ovarian antral follicle count (AFC). Age, body mass index (BMI), number of oocytes retrieved, mature oocytes, top quality embryo et al were recorded. The primary outcome measure of the study were the number of oocytes retrieved and poor ovarian response. Poor response was defined as fewer than five oocytes were retrieved; normal response was defined as more than five; those patients with OHSS were assigned to the OHSS group. The secondary outcome measure was clinical pregnancy. SPSS11.5 was applied for analysing each of the corresponding parameters between groups.
Results:(1) The AMH levels on the basal line, day 5 Gn administration and hCG administration were significantly lower in poor ovarian responders than in the normal responders and ovarian hyperstimulation syndrome, the difference was statistically significant (p＜0.05); the AMH levels on the three different phases of IVF-ET were significantly higher in OHSS patients than in the normal responders, the difference was statistically significant (p＜0.05)(2) Day 2-4, day 5 Gn adminstration and hCG administration AMH were not statistically significantly different in pregnant and non pregnant group (p＞0.05) (3) Day 2～4, day 5 Gn adminstration and hCG administration AMH show a good discriminatory potential for predicting poor response (area under the receiver operating characteristics cerves,0.923,0.932and0.934, respectively).
Conclusions:(1)The serum AMH levels of different phases during the IVF-ET treatment cycle can predicted ovarian poor response better than clinical indicators used currently, the sensitiving is better. (2) The serum AMH levels of different phases during the IVF-ET treatment cycle can not predict the outcome of pregnancy. (3)For ovarian poor responder, the AMH level on day 2～4 of the menstrual cycle, day 5 Gn administration and hCG administration, the each Cut-off value 1.72ng/ml,0.87 ng/ml,0.28 ng /ml as the criterion, the sensitivity and specificity of prediction can reach 80%.
方法：选择60例行IVF-ET治疗的患者,于月经第2-4天采用酶联荧光法测定基础血清卵泡刺激素(follicle stimulating hormone, FSH)、促黄体生成素(luteinizing hormone, LH)、雌二醇(estradiol, E2),同时应用超声行卵巢窦卵泡计数(antral follicle count, AFC)。于月经第2-4天、促性腺素刺激卵巢第5日、注射hCG日采用酶联免疫吸附法(ELISA)测定血清AMH水平；记录年龄、体重指数(BMI)、获卵数、成熟卵子数、优质胚胎数等。反应性以获卵数分组,获卵数≤5枚为低反应组,>5枚为正常反应组,出现卵巢过度刺激(OHSS)的为OHSS组；妊娠结局以是否怀孕分组,分为临床妊娠组及未妊娠组。应用SPSS11.5软件的相关统计方法对上述各分组间的相应指标进行分析比较。
结果：(1)低反应组与正常反应组及OHSS组相比其基础日、Gn刺激第5日及hCG日的血清AMH均明显降低,差异有统计学意义(p＜0.05); OHSS组与正常反应组相比其基础日、Gn刺激第5日及hCG日的血清AMH均明显升高,差异有统计学意义(p<0.05)；(2)妊娠组与未妊娠组相比,基础日、Gn第5日及hCG日血清AMH水平均无统计学差异(p＞0.05)；(3)基础日、Gn第5日及hCG日血清AMH预测卵巢低反应性ROC曲线下面积(ROCA(?)C)分别为0.923,0.932,0.934。
结论：(1))在IVF过程中各阶段的血清AMH水平与目前临床常用指标相比,对卵巢反应性预测诊断价值相对较高、较灵敏。(2)IVF过程中各阶段的AMH均无法预测妊娠结局。(3)若基础日、Gn第5日及hCG日的AMH水平分别以Cut-off值为1.72ng/ml、0.87 ng/ml、0.28 ng/ml作为判断标准的话,其预测低反应性的敏感性及特异性均可达80%左右。
Objective:To explore the predictive value of anti-Mullerian hormone (AMH/MIS) level during different phases of in vitro fertilization and embryo transfer (IVF-ET) treatment cycle on ovarian response and clinical-pregnancy outcome.
Methods:A total of 60 patients undergoing IVF was prospectively recruited. On day 2-4 of the menstrual cycle, levels of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) were measured by enzyme-linked fluorescent assay. Serum AMH levels were measured on day 2～4 of the menstrual cycle, day 5 gonadotropin (Gn)administration and hCG administration by enzyme-linked immunosorbent assay (ELISA); and ultrasound evaluation of ovarian antral follicle count (AFC). Age, body mass index (BMI), number of oocytes retrieved, mature oocytes, top quality embryo et al were recorded. The primary outcome measure of the study were the number of oocytes retrieved and poor ovarian response. Poor response was defined as fewer than five oocytes were retrieved; normal response was defined as more than five; those patients with OHSS were assigned to the OHSS group. The secondary outcome measure was clinical pregnancy. SPSS11.5 was applied for analysing each of the corresponding parameters between groups.
Results:(1) The AMH levels on the basal line, day 5 Gn administration and hCG administration were significantly lower in poor ovarian responders than in the normal responders and ovarian hyperstimulation syndrome, the difference was statistically significant (p＜0.05); the AMH levels on the three different phases of IVF-ET were significantly higher in OHSS patients than in the normal responders, the difference was statistically significant (p＜0.05)(2) Day 2-4, day 5 Gn adminstration and hCG administration AMH were not statistically significantly different in pregnant and non pregnant group (p＞0.05) (3) Day 2～4, day 5 Gn adminstration and hCG administration AMH show a good discriminatory potential for predicting poor response (area under the receiver operating characteristics cerves,0.923,0.932and0.934, respectively).
Conclusions:(1)The serum AMH levels of different phases during the IVF-ET treatment cycle can predicted ovarian poor response better than clinical indicators used currently, the sensitiving is better. (2) The serum AMH levels of different phases during the IVF-ET treatment cycle can not predict the outcome of pregnancy. (3)For ovarian poor responder, the AMH level on day 2～4 of the menstrual cycle, day 5 Gn administration and hCG administration, the each Cut-off value 1.72ng/ml,0.87 ng/ml,0.28 ng /ml as the criterion, the sensitivity and specificity of prediction can reach 80%.
引文
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