AMH在合并AITD不孕女性卵巢储备功能评估中的作用及对控制性超促排卵结局的影响

Anti-Müllerian hormone in evaluating ovarian reserve among women with autoimmune thyroid disease undergoing controlled ovulation hyper-stimulation

目的探讨抗米勒管激素(AMH)在不孕合并甲状腺自身免疫性疾病(AITD)患者卵巢储备功能评估中的作用及对控制性超促排卵(COH)手术结局的影响。方法选取首次行体外受精(IVF)手术的不孕患者245例,根据有无合并AITD分为AITD组和无AITD组。收集所有对象的一般资料,同时检测其经期第3天的血清促甲状腺激素(TSH)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、催乳素(PRL)水平及经期第21天的孕酮水平。根据AMH水平将所有患者分为高AMH组和低AMH组。结果与无AITD组比较,AITD组AMH水平降低(P<0.05),FSH水平升高(P<0.05)。2个组之间年龄、体质量指数(BMI)、TSH、E2、PRL、LH、孕酮水平及合并多囊卵巢综合征、子宫内膜异位症比例差异均无统计学意义(P>0.05)。AITD组的重组人卵泡刺激素(r-FSH)用量明显高于无AITD组(P<0.001),卵巢刺激后的E2/r-FSH比值明显低于无AITD组(P<0.001)。AITD组取出MⅡ卵母细胞的例数和一级胚胎存活例数与无AITD组比较,差异均无统计学意义(P>0.05)。无论是高AMH组,还是低AMH组,合并AITD的不孕患者AMH水平、E2/r-FSH比值均低于无AITD的不孕患者(P<0.05),r-FSH用量高于无AITD的不孕患者(P<0.05),FSH、TSH及一级胚胎存活例数差异均无统计学意义(P>0.05)。在低AMH组中,合并AITD的不孕患者取出MⅡ卵母细胞的例数明显低于无AITD的不孕患者(P<0.001)。在高AMH组中,合并AITD的不孕患者取出MⅡ卵母细胞的例数与无AITD的不孕患者比较,差异无统计学意义(P>0.05)。结论在不孕患者中,AMH低表达(卵巢储备减少)和合并AITD均可使COH结局产生不良影响,建议在行COH前同时进行卵巢储备功能评估和AITD筛查。

Objective To evaluate the role of serum anti-Müllerian hormone(AMH)in infertile women with autoimmune thyroid disease(AITD)and its influence on the outcome of controlled ovulation hyper-stimulation(COH).Methods A total of 245 infertile women who underwent in vitro fertilization(IVF)for the first time were classified into AITD positive group and AITD negative group.Thyroid stimulating hormone(TSH),follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2)and prolactin(PRL)and progesterone on the 3rd and 21st days of menstrual period were determined.According to the levels of AMH,the patients were classified into low-level and high-level AMH subgroups.Results Compared with AITD negative group,the level of AMH in AITD positive group was decreased(P<0.05),and the level of FSH was increased in AITD positive group(P<0.05).There was no statistical significance in age,body mass index(BMI),TSH,E2,PRL,LH,progesterone,polycystic ovary syndrome and endometriosis between the 2 groups(P>0.05).The dosage of recombinant follicle stimulating hormone(r-FSH)in AITD positive group was higher than that in AITD negative group(P<0.001),the ratio of E2/r-FSH was lower(P<0.001).There was no statistical significance in the numbers of MⅡoocytes and primary embryo survival between AITD positive and negative groups(P>0.05).The AMH level and E2/r-FSH ratio in AITD positive group were lower than those in AITD negative group(P<0.05),the dosage of r-FSH was higher(P<0.05),and there was no statistical significance for FSH,TSH and the number of primary embryo survival(P>0.05).In the low AMH group,the number of MⅡoocytes in AITD positive group was lower than that in AITD negative group(P<0.001).In the high AMH group,there was no statistical significance in the number of MⅡoocytes between AITD positive and negative groups(P>0.05).Conclusions In infertile women,the low expression of AMH(low ovarian reserve)and AITD status have negative impacts on the outcome of COH.AITD should be accessed in which the ovarian reserve function is evaluated before COH.