抗苗勒氏管激素联合卵泡输出率对体外受精-胚胎移植治疗临床结局的预测价值

The predictive value for AMH combined with follicular output rate in the treatment of in vitro fertilization-embryo transfer

目的探讨抗苗勒氏管激素联合卵泡输出率对体外受精-胚胎移植治疗临床结局的预测价值。方法通过队列研究选择2016年6月-2017年6月在我院行IVF-ET治疗的患者748例,按血AMH及FORT值采用四分位法各分为3组。分别比较不同AMH及不同PORT各组患者间的基本资料及助孕结局。如患者年龄、BMI、bFSH、Gn时间、Gn剂量、获卵数、HCG日E2水平、可移植胚胎数、临床妊娠率、胚胎种植率及OHSS发生率等。结果根据AMH四分位法分组中AMH越高的患者,AFC及PFC越多,获卵数及HCG日E2水平及可移植胚胎数均与AMH成正比,但是FORT随着AMH增加而降低,且组间比较均存在显著性差异,3组患者的临床妊娠率及胚胎种植率均无显著性差异,OHSS发生率高AMH组高于低中AMH组。根据FORT4分位法分组患者年龄、BMI、bFSH及AMH均无显著性差异。AFC越高的患者,FORT越低,随FORT的增加患者的获卵数、HCG日E2水平及可移植胚胎数均相应增加,低FORT患者较高FORT患者的Gn时间更长,Gn量更多,且组间比较均存在显著性差异。但是3组患者的AMH、胚胎种植率、临床妊娠率均无显著性差异,OHSS发生率随FORT增加有增高趋势。结论 AMH及FORT的高低对IVF-ET助孕治疗新鲜胚胎移植的临床妊娠率无直接影响,但是随着AMH及FORT的增加,患者的可移植胚胎数显著增加,可能增加累积妊娠率,但是OHSS发生率有增加趋势。

Objective To investigate the predictive value of Anti-mullet hormone combined with Follicular output rate in the treatment of in vitro fertilization and embryo transfer. Methods A cohort study selected 748 patients who received IVF-ET treatment in jiangxi maternal and child health hospital Reproduction from June 2016 to June 2017. Patients according to the AMH and FORT were divided into three groups by quartering method. Compared the basic data and IVF outcomes of patients in different AMH and different PORT groups. Such as patients' age,BMI,bFSH,days anf dosage of gonadotropin(Gn),number of eggs obtained,HCG day E2 level,number of transplantable embryos,clinical pregnancy rate,embryo implantation rate and OHSS incidenced,etc. Results Patients divied to 3 groups according to AMH quarter,who with higher AMH have more AFC and PFC. Oocytes received,E2 level on the HCG day and the number of embryos were positively correlated with AMH. But FORT decreases as AMH increases,and there are significant differences between each groups,The clinical pregnancy rates and embryo cultivation rate had no significant difference in each group. OHSS occurred in high AMH group more than the low group. According to PORT quarter patients divied to 3 groups,there were no significant differences in patients' age,BMI,bFSH and AMH. The more AFC and the lower FORT was. With the increase of FORT,the number of eggs obtained,E2 level on the HCG day and the number of transplantable embryos increased correspondingly. The days and dosages of Gn in low FORT group were more than high group,and there were significant differences between each groups. However,there were no significant differences in AMH,embryo implantation rate and clinical pregnancy rate among the three groups,and the OHSS incidence increased with the FORT increase. Conclusion The AMH and FORT index have no direct effect on the clinical pregnancy rate of fresh embryo transfer in IVF-ET. However,with the increase of AMH and FORT indes,the number of transplantable embryos significantly increased,whic may increased the cumulative pregnancy rate,and the incidence of OHSS may increasing.