抗苗勒管激素在IVF治疗多囊卵巢综合征患者中的应用价值探讨

To Investigate the Value of Anti-Müllerian Hormone in Patients with Polycystic Ovary Syndrome During in vitro Fertilization

比较体外授精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)治疗中多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者与非PCOS患者基础血清及卵泡液抗苗勒管激素(anti-müllerian hormone,AMH)水平;分析AMH与PCOS患者的临床特征、IVF结局的关系;进一步探讨AMH在IVF治疗PCOS患者中的应用价值.回顾性分析2010年8月至2012年6月本生殖中心行IVF-ET治疗的69例PCOS患者和95例排卵正常非PCOS患者的临床资料,比较两组间血清AMH水平、取卵日卵泡液AMH水平之间的差异,并对相应的IVF结果进行比较.使用t检验、Spearman相关系数、多重线性回归方程行统计学分析.结果显示,(1)PCOS组血清AMH、黄体生成素(luteinizing hormone,LH)、睾酮(testosterone,T)水平、LH/FSH比值卵泡刺激素(follicle stimulating hormone,FSH)、基础窦卵泡数(antralfolliclecount,AFC)、体重指数(body mass index,BMI),总获卵数均明显高于对照组(P<0.05);(2)对照组中,血清基础AMH水平与基础窦卵泡数、总获卵数及MⅡ成熟卵数呈正相关(P<0.05),与年龄呈负相关(P<0.05);PCOS组血清基础AMH水平与基础窦卵泡数呈正相关(P<0.05),但与总获卵数、MⅡ成熟卵数及年龄均无相关性(P>0.05).两组患者血清AMH水平均与垂体促性腺激素(gonadotropin,Gn)用量呈负相关(P<0.05);(3)两组患者卵泡液AMH水平与血清基础AMH水平呈明显正相关(P<0.05).PCOS组正常受精的卵母细胞卵泡液中AMH水平低于异常受精者(P<0.05);对照组正常受精的卵母细胞卵泡液中AMH水平与异常受精者无差异,但低于PCOS组正常受精的卵母细胞卵泡液中AMH水平(P<0.05);(4)两组卵泡液AMH水平均与相应的胚胎质量无相关性(P>0.05).PCOS患者血清基础AMH水平与AFC数量有较强的相关性,在PCOS患者血清基础AMH水平及AFC明显升高的情况下,采用相对较低的Gn起始剂量,对减少PCOS患者卵巢过度刺激综合征的发生及获得理想的卵泡数有重要临床指导意义.另外PCOS患者卵泡液AMH水平升高可能会影响卵母细胞发育潜能及其正常受精,为预测卵母细胞能否正常受精提供了新的指标.但卵泡液AMH水平并不能预测相应胚胎质量及临床妊娠结果.

To compare serum basal and follicular fluid levels of AMH in patients with PCOS and non-PCOS that in the treatment of IVF-ET;analyze the relationship of AMH with clinical characteristics and IVF outcomes of patients with PCOS;further to investigate the value of AMH in patients with PCOS during IVF treatment.A retrospective analysis was performed on patients accepted IVF-ET treatment in our center from August 2010 to June 2012,who were divided into two groups,69 PCOS patients and 95 non-PCOS patients with normal ovulation to analysis the basal serum and follicular fluid AMH levels and IVF outcomes between the two groups.The results showed that,(1)Levels of serum AMH,LH,T,LH/FSH ratio,AFC,BMI and the total number of retrieved oocytes in PCOS group were significantly higher than these of control group(P<0.05).(2)In control group,the serum AMH level has a significantly positive correlation with AFC,the total number of retrieved oocytes and the number of mature eggs(P<0.05),but it has a negative correlation with age(P<0.05);in PCOS group,the serum AMH level has a significantly positive correlation with AFC(P<0.05),but no correlation was found with the total number of retrieved oocytes,the number of mature eggs and age(P>0.05).The serum AMH level has a negative correlation with Gonadotropin dosage in both groups(P<0.05).(3)Levels serum of AMH and follicular fluid have a significantly positive correlation(P<0.05).The AMH level in follicular fluid of normal fertilized oocytes was lower than that of abnormal fertilized oocytes in PCOS group,no difference was found in follicular fluid AMH level between normal and abnormal fertilized oocytes in control group,but follicular fluid AMH level of normal fertilized oocytes in control group was lower than that of PCOS group(P<0.05).(4)No correlation was found between follicular fluid AMH level and corresponding embryo quality in both PCOS and controls(P>0.05).The basal serum AMH level in PCOS patients has a strong correlation with the AFC.A relatively low initial dose of Gonadotropin has an important clinical significance in reducing the incidence of OHSS and obtaining an ideal number of oocytes in PCOS patients with high basal serum AMH and AFC.In addition,the elevated follicular fluid AMH level might affect the potential development of oocyte and its normal fertilization,thus,providing a new marker to predict the oocyte normal fertilization.While the levels of AMH in follicular fluid could not predict the embryo quality and clinical pregnancy outcome.