血清及卵泡液抗苗勒管激素在多囊卵巢综合征患者体外受精促排卵治疗中的价值

The values of serum and follicular fuild anti-mullerian hormone levels of PCOS patients on predicting the outcomes of IVF/ICSI

目的：探讨长方案及拮抗剂方案的多囊卵巢综合征（polycystic ovary syndrome,PCOS）患者血清及卵泡液中抗苗勒管激素（anti-Mullerian hormone,AMH）水平对体外受精（IVF）结局的预测价值。方法：本前瞻性研究将59例行IVF治疗的PCOS患者随机分为口服避孕药后长方案（OC＋LP）30例和拮抗剂方案组29例,分别测定IVF治疗前一月经周期第2-5天（bAMH）、启动日（Gn日AMH）、取卵日（OPU日AMH）及卵泡液（FF AMH）的AMH水平,比较两组临床、实验室指标及AMH值,并分析AMH在促排卵过程中的变化。结果：OC＋LP组和拮抗剂组获卵数、成熟率、受精率、种植率及临床妊娠率等差异均无统计学意义（P〉0.05）,两组同一时间点AMH值比较差异均无统计学意义（P〉0.05）,无论是OC＋LP组还是拮抗剂组,同一组内不同时间点AMH值比较显示,OPU日血清AMH水平均显著低于b AMH、Gn日AMH及FF AMH,差异具有统计学意义（P〈0.05）,而后三者两两相比,差异均无统计学意义（P〉0.05）。两组合并后按妊娠结局分临床妊娠组22例和非妊娠组20例,其年龄、获卵数、优质胚胎率、bAMH、Gn日AMH、OPU日AMH及FF AMH值差异均无统计学意义（P〉0.05）。结论：PCOS患者无论行长方案或拮抗剂方案,均不影响AMH对其卵泡发育的调控;血清及成熟卵泡液中AMH水平均不能预测PCOS患者IVF临床结局。

AIM： To study the values of serum and follicular fluid anti-mullerian hormone（ AMH）levels on predicting the outcomes of IVF of PCOS undergoing different controlled ovarian stimulation（ COS） protocols including agonist protocol and antagonist protocol. METHODS： This prospective study included 59 PCOS patients who were divided into GnRH agonist long-protocol（ OC ＋ LP,30 patients） and GnRH antagonist multiple-dose flexibleprotocol（ GnRH-A,29 patients） randomly. Serum AMH was determined on the 2- 5 day of natural cycle before IVF（ b AMH）,the Gn-treated day（ Gn AMH） and the oocyte pick-up day（ OPU AMH）,follicle fluid was collected on OPU day（ FF AMH）.The clinical,laboratorial indexs and AMH levels in two groups were compared,and the variantion trend of serum AMH level during COS procedure was analysed. RESULTS： There were no significant differences of the oocyte number and the rates of maturation,fertilization,implantation and clinical pregnancy between two stimulation protocols（ P〉0. 05）.There were no differences of serum or FF AMH level in the same time between two groups（ P〉0. 05）.The level of OPU AMH was significantly lower than that of b AMH,Gn AMH or FF AMH（ P〉0. 05）whether in OC ＋ LP or GnRH-A group,but there were no differences in the later threes（ P〉0. 05）.According to the clinical outcomes of IVF,two protocols combined,all cases divided into two groups：clinical pregnancy group（ 22 cases） and non-pregnancy group（ 20 cases）. There were no significant differeces of the mean ages,the oocyte numbers,the rates of good-quality embryos,the levels of b AMH,Gn AMH and FF AMH（ P〉0. 05）. CONCLUSION： The role of AMH on regulation of follicular development is not affected during agonist and antagonist protocols of IVF in PCOS patients. Whether serum or follicular fluid AMH values can not predict the clinical outcomes of PCOS women undergoing IVF.