血清AMH水平联合FSH/LH预测PCOS不孕症促排卵效果和妊娠率的临床

Clinical significance of serum AMH level combined with FSH/LH in predicting ovulation induction and pregnancy rate of PCOS infertility

目的探讨血清抗苗勒氏管抑制因子(Anti-mullerian hormone,AMH)水平联合卵泡刺激素/促黄体生成素(Follicular stimulating hormone/Luteinizing hormone,FSH/LH)预测多囊卵巢综合征(polycystic ovary syndrome,PCOS)不孕症促排卵效果和妊娠率的临床。方法随机选取2015年2月至2019年2月在我院就诊的PCOS患者162例为试验组,同时选择非PCOS患者1618例为对照组,所有患者均采用标准长方案进行控制性超促排卵,于自然周期排卵后5-7天或口服避孕药周期月经第21天开始应用促性腺激素释放激素激动剂(Gonadotropin-releasing hormone agonist,GnRHa)进行垂体降调节,每日应用GnRHa 0.05mg皮下注射。分析两组患者的年龄、不孕年限、体重指数、FSH/LH比值、AMH、血清雌二醇(Oestradiol,E2)水平、启动FSH剂量、促性腺激素(Gonadotrophin hormone,Gn)天数、Gn总量、排卵前成熟卵泡计数(Preovulatory follicle count,PFC)、卵泡输出率(Follicular output rate,FORT)、获卵数、移植胚胎数、胚胎总数、2PN受精率和优质胚胎率等指标。结果(1)通过对两组患者临床妊娠率和未妊娠率进行比较分析,结果显示,FSH/LH比值、AMH、E2、AFC、启动FSH剂量、Gn天数、Gn总量、PFC、FORT、获卵数、移植胚胎数、胚胎总数、2PN受精率和优质胚胎率在两组之间比较差异有统计学意义(P<0.05)。(2)试验组中低FORT组、中等FORT组和高FORT组的促排卵泡和妊娠率均低于对照组,促排卵泡和妊娠率在两组之间比较差异无统计学意义(P<0.05)。结论血清AMH水平联合FSH/LH可以作为PCOS患者诊断的指标之一。

Objective:To investigate the clinical significance of serum AMH level combined with FSH/LH in predicting ovulation induction and pregnancy rate in infertility in PCOS.Methods:A total of 162 patients with PCOS who were admitted to our hospital from February 2015 to February 2019 were randomly selected as the experimental group,and 1618 patients with non-PCOS were selected as the control group.All patients underwent controlled ovarian hyperstimulation using standard long-term regimen.The pituitary downregulation was started with the gonadotropin-releasing hormone agonist GnRHa on the 21st day after ovulation in the natural cycle or on the 21st day of the oral contraceptive cycle.GnRHa 0.05 mg was administered subcutaneously daily.The age,infertility,body mass index,FSH/LH ratio,anti-Mullerian hormone(AMH),serum estradiol(E2)level,starting dose,embryo implantation rate and clinical pregnancy rate were analyzed.Results:(1)By comparing the clinical pregnancy rate and non-pregnancy rate of the two groups of patients,the results showed that FSH/LH ratio,AMH,E2,AFC,FSH dose,Gn days,Gn total,PFC,FORT,The number of eggs obtained,the number of embryos transplanted,the total number of embryos,the fertilization rate of 2PN and the rate of high quality embryos were significantly different between the two groups(P<0.05).(2)The follicle stimulating rate and pregnancy rate in the low FORT group,the middle FORT group and the high FORT group in the experimental group were lower than those in the control group,and the ovarian follicle stimulating rate and pregnancy rate were not significantly different between the two groups(P<0.05).Conclusion:Serum AMH level combined with FSH/LH can be used as one of the indicators for the diagnosis of PCOS patients.