FSH/LH在AMH正常人群中评估卵巢低反应的价值

The value of FSH/LH in assessing poor ovarian response in normal AMH population

目的研究在抗苗勒管激素(anti-müllerian hormone,AMH)正常人群中,促卵泡激素与黄体生成素比值(follicle-stimulating hormone/luteinizing hormone,FSH/LH)升高是否与卵巢低反应的发生相关,以期找到诊断临界值。方法分析我院生殖中心进行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)助孕的周期4363个,通过平滑曲线拟合分析在1.1<AMH<6μg/L人群中FSH/LH与卵巢低反应发生的关系,寻找阈值或饱和点,根据找到的阈值或饱和点分组,比较两组人群特征、周期信息、周期结局,分析FSH/LH升高与卵巢低反应及周期结局的变化。结果在AMH正常人群中,通过平滑曲线拟合发现,随FSH/LH水平增加,卵巢低反应发生增加,但通过阈值与饱和分析找出最佳饱和点为3.3。通过FSH/LH≥3.3组与FSH/LH<3.3组比较,年龄、体重指数、FSH、促性腺激素(gonadotropins,Gn)启动剂量、Gn总剂量均显著升高;AMH、窦卵泡数(antral follicle counting,AFC)、基础LH、雌激素(estrogen,E2)、获卵总数、可移植胚胎率、扳机日E2、孕激素(progesterone,P)水平均降低(P<0.05)。结论在控制性超促排卵过程中,AMH是预测卵巢反应性的可靠指标。在AMH正常人群中,随FSH/LH升高卵巢低反应的发生率增加,FSH/LH=3.3为饱和值,但预测卵巢低反应发生的准确率仅有23%,FSH/LH升高的人群中,FSH升高及LH降低都与卵巢低反应发生相关。FSH/LH升高使最终获卵率及可移植胚胎率降低,但不影响优质胚胎率及最终的妊娠率。

Objective To study whether the increase of follicle-stimulating hormone/luteinizing hormone(FSH/LH)in the population with normal anti-müllerian hormone(AMH)is related to the occurrence of poor ovarian response(POR),in order to determine the diagnostic threshold.Methods A total of 4363 cycles of patients undergoing in vitro fertilization-embryo transfer(IVF-ET)at the reproductive center of our hospital were analyzed.The relationship between FSH/LH and POR in the population with 1.1<AMH<6μg/L was analyzed through the method of smooth curve fitting,to find the threshold or saturation point,based on which the population was grouped.The population characteristics,cycle information,and cycle outcome of the two groups were compared,and an increase in FSH/LH,and changes in POR and cycle outcome were analyzed.Results In the population with normal AMH,smooth cure fitting found that with the increase of FSH/LH level,the incidence of POR was increased,and the optimal saturation point was 3.3 by threshold and saturation analysis.By comparing FSH/LH>3.3 group with FSH/LH<3.3 group,age,body mass index(BMI),FSH,the starting dose of gonadotropins(Gn)and the total dose of Gn were significantly increased,whereas AMH,AFC,basal LH,E2,the total number of eggs obtained,the rate of transferable embryos,the E2 and P levels on the trigger day were all decreased(P<0.05).Conclusion In the process of controlled ovarian hyperstimulation(COH),AMH is a reliable indicator to predict ovarian responsiveness.In the population with normal AMH,the incidence of POR increases with the increase of FSH/LH.FSH/LH:3.3 is a saturation value,but the accuracy of predicting the occurrence of POR is only 23%.In the population with elevated FSH/LH,both the increase of FSH and the decrease of LH are related to the occurrence of POR.The increase of FSH/LH reduces the final number of eggs obtained and the rate of transferable embryos,but does not affect the rate of high-quality embryos and the final pregnancy rate.