抗苗勒管激素水平对多囊卵巢综合征患者行卵泡期长效长方案助孕结局的影响

Effect of anti-mullerian hormone level on pregnancy outcome in patients with polycystic ovary syndrome by using long-acting GnRH agonist long protocol in follicular phase

目的探讨不同抗苗勒管激素(AMH)水平对多囊卵巢综合征(PCOS)患者行卵泡期长效长方案助孕结局的影响。方法收集2016年3月至2017年10月于郑州大学第一附属医院生殖医学中心首次行IVF/ICSI-ET助孕治疗并采用卵泡期长效长方案的PCOS患者的临床资料。根据血清AMH水平按照四分位法将患者分成3组:低水平组(<25%,AMH水平<5.21ng/ml,n=172)、中水平组(25%～75%,AMH水平5.21～10.49ng/ml,n=344)、高水平组(>75%,AMH水平>10.49ng/ml,n=172),比较各组间PCOS患者临床特征及治疗结局的相关指标。结果高水平组基础LH、T水平、LH/FSH比值、Gn使用时间、HCG日E2水平、获卵数、2PN数、2PN卵裂数及可移植胚胎数均显著高于其他两组(P<0.05),而Gn启动剂量、优质胚胎率及新鲜周期移植率则显著低于其他两组(P<0.05);低水平组Gn用量显著高于其他两组(P<0.05);3组患者年龄、不孕年限、BMI、基础FSH、E2水平、空腹血糖水平、优质胚胎数、2PN受精率、2PN卵裂率、中重度OHSS发生率、胚胎种植率、HCG阳性率、临床妊娠率、活产率、多胎妊娠率均无统计学差异(P>0.05)。多因素Logistic回归分析显示,AMH水平并不是PCOS患者临床妊娠的影响因素(P>0.05)。结论 AMH水平与PCOS患者临床特征密切相关。PCOS患者AMH水平越高,Gn使用时间越长并且优质胚胎率越低,但并未发现AMH水平对临床妊娠有明显影响。

Objective:To investigate the effect of different anti-mullerian hormone(AMH)level on the pregnancy outcome in patients with polycystic ovary syndrome(PCOS)by using long-acting GnRH agonist long protocol in follicular phase.Methods:The clinical data of PCOS patients who underwent IVF/ICSI-ET for the first time by using the long-acting GnRH agonist long protocol in follicular phase in Reproductive Medicine Center,the First Affiliated Hospital of Zhengzhou University from March 2016 to October 2017 was collected in this study.According to serum AMH levels,the PCOS patients were divided into three groups by the quartile method:low-level group(<25%,AMH level<5.21 ng/ml,n=172);medium-level group(25% ~75%,AMH level 5.21~10.49 ng/ml,n=344);high-level group(>75%,AMH level>10.49 ng/ml,n=172).The clinical characteristics and treatment outcome were compared among three groups.Results:The basal LH,testosterone(T)level,LH/FSH value,duration Gn used,E2 on HCG day,the number of oocytes retrieved,the number of 2 PN,2 PN cleavage and available embryos were significantly higher in high-level AMH group than the others(P<0.05),but Gn initial dose,high quality embryo rate and the fresh cycles transplantation rate were significantly lower than the others(P<0.05).Gn dosage in low-level group was significantly higher than the others(P<0.05).The doses of Gn used in the low-level AMH group were significantly higher than the other two groups(P<0.05).There were no significant differences in age,infertility duration,BMI,basal FSH and E2 level,fasting blood glucose level,number of high quality embryos,2 PN fertilization rate,2 PN cleavage rate,incidence of moderate to severe OHSS,embryo implantation rate,HCG positive rate,clinical pregnancy rate and live birth rate,multiple pregnancy rate among the three groups(P>0.05).Multivariate logistic regression analysis showed that AMH level was not a influence factor in clinical pregnancy in patients with PCOS(P>0.05).Conclusions:The level of AMH is closely related to the severity and clinical features of PCOS patients.The higher the AMH level in patients with PCOS,the longer duration of Gn used and the lower the quality embryo rate.However,AMH level has no effect on clinical pregnancy in PCOS patients.