抗苗勒氏管激素水平对IVF-ET妊娠结局的预测价值评估

Predictive value of anti-mullerian hormone on pregnancy outcome of IVF-ET

目的评估抗苗勒氏管激素（AMH）水平对于体外受精-胚胎移植（IVF-ET）临床妊娠结局的预测价值。方法选择在本中心行IVF/ICSI治疗的患者150例,按年龄将其分为〈35岁组（n=90）和≥35岁组（n=60）。于月经第2~4d测定患者的血清基础卵泡刺激素（bFSH）和基础AMH（bAMH）水平,同时进行阴道B超窦卵泡计数（AFC）;于患者接受促性腺激素（Gn）刺激卵巢第6天测定血清AMH水平（Gn6AMH）及取卵日测定其卵泡液中AMH水平（FFAMH）。评估各检测指标与IVF-ET临床妊娠结局的相关性,并绘制患者受试工作曲线（ROC）,分析并寻找各检测指标预测IVF-ET临床妊娠结局的临界点。结果患者年龄〈35岁时,卵泡液中AMH水平（FFAMH）与IVF-ET临床妊娠结局有显著正相关性（r=0.468,P〈0.01）,当FFAMH水平≥6.590ng/ml时其预测IVF-ET临床妊娠结局的敏感度为78.8%,特异性为81.6%,曲线下面积ROC-AUC为0.859（P〈0.01）,具有良好的预测价值;患者年龄≥35岁时,各个测定指标与临床妊娠结局均无显著相关性（P〉0.05）。结论对于年轻患者（年龄〈35岁）,卵泡液中AMH水平对IVF-ET临床妊娠结局有较高的预测价值;当患者年龄≥35岁时,AMH水平无法预测其临床妊娠结局。

Objective： To investigate the predictive value of anti-mullerian hormone（AMH）on the pregnancy outcome of IVF-ET.Methods： A total of 150 women undergone IVF/ICSI in our reproductive center were divided into two groups：groupⅠ（age35,n=90）and groupⅡ（age≥35,n=60）.Basal serum levels of AMH FSH and antral follicle count（AFC）were measured on Day 2to Day 4.AMH level was measured on Day 6after administration of gonadotrophin（Gn）.AMH level was also measured in follicle fluid on the day of oocytes picked-up.The correlation between AMH level and the pregnancy outcome of IVF-ET were evaluated.Receiver operating characteristic（ROC）curves were constructed to find the cut-off value of AMH and other parameters in predicting clinical pregnancy rate（CPR）.Results： When the patients＇ age were less than 35 years,clinical pregnancy rate was correlated with AMH levels in follicle fluid（r=0.468,P〈0.01）.When AMH levels in follicle fluid were≥6.590ng/ml,the sensitivity in predicting clinical pregnancy rate was 78.8% the specificity 81.6%,and the ROC-AUC was 0.859（P〈0.01）.When patients aged≥35years,no associations were found between AMH and CPR（P〈0.05）.Conclusions： AMH level in follicle fluid is significantly correlated with clinical pregnancy rate in patients aged35years.There is no association between AMH and CPR in patients aged≥35years.