卵泡液中AMH水平与卵巢反应性及妊娠结局关系的探讨

Discussion on relationship between anti-müllerian hormone in follicular fluid with ovarian response and pregnancy outcomes

目的研究卵泡液中抗苗勒氏管激素(follicular fluid anti-müllerian hormone,FFAMH)水平与控制性超促排卵(controlled ovarian hyper-stimulation,COH)过程中卵巢反应性与妊娠结局的关系。方法选择在北京大学第一医院妇产科生殖与遗传医疗中心行COH治疗的137例不孕症女性为研究对象,依据卵巢反应性将其分为三组。采用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)方法检测各组FFAMH浓度。结果卵巢低反应组、正常反应组和高反应组卵泡液中AMH水平比较,其差异具有统计学意义(P<0.001);进行组间比较后,卵巢低反应组与正常反应组、高反应组之间的FFAMH水平差异,均具有统计学意义(均P<0.001);而卵巢正常反应组与高反应组之间的FFAMH水平差异无统计学意义(P=0.399)。113例实行新鲜周期移植的不孕症女性中,妊娠组与未妊娠组的FFAMH水平比较,其差异具有统计学意义(P<0.001)。FFAMH水平对妊娠结局有一定的预测效能,但预测价值较低(AUC=0.688)。结论在COH治疗过程中,FFAMH水平与卵巢反应性和临床妊娠结局相关。FFAMH水平对妊娠结局有一定的预测效能,但预测价值较低。

Objective To study the relationship between follicular fluid anti-müllerian hormone(FFAMH) level and ovarian response and clinical pregnancy outcomes in the procedure of controlled ovarian hyper-stimulation(COH). Methods A total of 137 infertile women undergoing IVF/ICSI were included in this study at the Reproductive and Genetic Medical Center of Peking University First Hospital. Patients were divided into three groups according to the number of retrieved oocytes: poor ovarian responders, normal ovarian responders, and high ovarian responders. The FFAMH levels were detected by ELISA. Results There were statistically significant differences in FFAMH level among three groups. The FFAMH level in the poor ovarian responders group was statistically much lower than that of normal responders group or high responders group(both P<0.001). There was no statistically significant difference in FFAMH level between normal responders group and high responders group(P=0.399). Among 113 infertile women undergoing fresh embryo transfer, the FFAMH level in non-pregnant women was statistically lower than that of pregnant ones(P<0.001). FFAMH had some association with predicting clinical pregnancy outcomes, but its predictive value was poor. Conclusions In the procedure of IVF/ICST treatment, FFAMH level is associated with ovarian response and pregnancy outcomes. FFAMH has some association with predicting clinical pregnancy outcome, but its predictive value was poor.