抗苗勒管激素水平及促性腺激素剂量与体外受精胚胎移植妊娠结局的关系

Relationship between anti-Müllerian hormone level,gonadotropin dose and pregnancy outcome of women accepted in vitro fertilization and embryo transfer

目的:探讨体外受精/卵胞浆内单精子显微注射(IVF/ICSI)治疗周期中血清抗苗勒管激素(AMH)水平、促性腺激素(Gn)剂量与妊娠结局的关系。方法:回顾性分析2016年5月至2018年8月于郑州大学第一附属医院生殖医学中心接受IVF/ICSI助孕的7050例患者的临床资料,根据AMH水平分为3组:<1μg/L 857例,1~4μg/L 4547例,>4μg/L 1646例,比较3组的基线资料和妊娠结局,logistic回归分析AMH水平、Gn剂量与妊娠结局的关系,绘制ROC曲线分析AMH水平、Gn剂量与妊娠结局的关系。结果:随着AMH水平增加,年龄、不孕时间、体重指数、基础FSH、Gn剂量呈下降趋势,获卵数与妊娠率呈上升趋势,移植胚胎数在AMH>4μg/L组最少,AMH 1~4μg/L组最多(P<0.05);logistic回归分析结果显示随着AMH水平升高,妊娠率呈上升趋势(P<0.05);在AMH<1μg/L组、AMH 1~4μg/L组,随着Gn剂量的增加妊娠率呈下降趋势(P<0.05);ROC曲线分析显示,在AMH<1μg/L组,AUC为0.571(95%CI为0.532~0.610),Gn剂量截断值为4093.73 IU,敏感度为0.495,特异度为0.648;在AMH 1~4μg/L组,AUC为0.618(95%CI为0.601~0.634),截断值为2668.66 IU,敏感度为0.631,特异度为0.447。结论:血清AMH水平与妊娠结局有关,在AMH<1μg/L与1~4μg/L时,Gn剂量与妊娠率有关,且对预测临床妊娠结局有一定的价值。

Aim:To explore the relationship between serum anti-Müllerian hormone(AMH)level and gonadotropin(Gn)dose during controlled ovarian hyperstimulation and pregnancy outcome during IVF/ICSI treatment.Methods:A retrospective analysis was performed on the clinical data of 7050 patients who received IVF/ICSI assisted pregnancy in Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University from May 2016 to August 2018.All were divided into 3 groups according to the AMH level[<1μg/L(857 patients),1-4μg/L(4547 patients),>4μg/L(1646 patients)].Baseline data and pregnancy outcomes were compared among the 3 groups.Logistic regression model was used to analyze the correlation between AMH and Gn doses and pregnancy,and the ROC curve was drawn to analyze different AMH levels and the relationship between Gn doses and pregnancy outcomes.Results:As the level of AMH increased,age,infertility time,body mass index,basal FSH and Gn dose showed a downward trend,while the number of retrieved oocytes and pregnancy rate showed an upward trend(P<0.05).The number of transferred embryos was the least in AMH>4μg/L group,and the most in AMH 1-4μg/L group(P<0.05).Logistic regression analysis showed that the pregnancy rate increased with the increase of AMH level(P<0.05).In the AMH<1μg/L group,AMH 1-4μg/L group,the pregnancy rate showed a downward trend as the dose of Gn increased(P<0.05).ROC curve analysis showed that in the AMH<1μg/L group,the AUC was 0.571(95%CI was 0.532-0.610),the Gn dose cut-off point was 4093.73 IU,the sensitivity was 0.495,and the specificity was 0.648;in AMH 1-4μg/L group,the AUC was 0.618(95%CI was 0.601-0.634),the cut-off point was 2668.66 IU,the sensitivity was 0.631,and the specificity was 0.447.Conclusion:Serum AMH levels are related to pregnancy outcomes.When AMH<1μg/L or AMH 1-4μg/L,the Gn dose is related to pregnancy rate and has certain value for predicting clinical pregnancy outcome.