AMH水平对IVF/ICSI早期妊娠丢失及累积妊娠结局的影响

Effects of anti-Müllerian hormone levels on early pregnancy loss and cumulative pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection

目的探讨抗苗勒管激素(anti-Müllerian hormone,AMH)水平对体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)早期妊娠丢失及累积妊娠结局的影响,AMH是否可以作为评价卵母细胞质量的指标。方法选取2015年12月至2019年12月期间于郑州大学第三附属医院生殖医学中心行IVF/ICSI助孕首次取卵周期的3701例女性进行回顾性队列分析,按年龄分为高龄组(≥35岁)和低龄组(<35岁),参考博洛尼亚和波塞冬标准,按AMH水平分为3组,低AMH组(AMH≤1μg/L)、中低AMH组(1μg/L<AMH<2μg/L)和正常AMH组(2μg/L≤AMH<6μg/L)。比较各组女性的一般资料及临床数据,探讨各组间早期妊娠丢失、累积妊娠率、累积活产率的差异。应用二元logistic回归,以正常AMH组为参照组,控制混杂因素(年龄、不孕原因、刺激方案、人绒毛膜促性腺激素注射日内膜厚度、基础卵泡刺激素水平),分析AMH水平对妊娠结局的影响。结果无论低龄或是高龄患者,不同AMH水平间每移植周期临床妊娠率、活产率、早期妊娠丢失率差异均无统计学意义(均P>0.05)。低龄患者中,低AMH组、中低AMH组和正常AMH组累积妊娠率分别为61.9%(211/341)、66.0%(319/483)、69.3%(1219/1760),差异具有统计学意义(P=0.020);累积活产率分别为50.1%(171/341)、57.8%(279/483)、57.1%(1005/1760),差异具有统计学意义(P=0.047)。二元逻辑回归校正混杂因素后,低龄患者中低AMH组累积妊娠率、累积活产率均低于正常AMH组(OR=0.617,95%CI=0.460~0.829,P=0.001;OR=0.660,95%CI=0.496~0.878,P=0.004);中低AMH组累积妊娠率、累积活产率低于正常AMH组,但差异均无统计学意义(均P>0.05)。高龄组中AMH水平不同的3组间累积妊娠率、累积活产率差异均无统计学意义(均P>0.05)。结论在行IVF/ICSI助孕女性首次取卵周期中,AMH水平与早期妊娠丢失的发生率无关。在低龄女性中,AMH水平是影响累积妊娠结局的独立影响因素,AMH≤1μg/L的女性助孕结局明显降低。在高龄女性中,AMH水平与累积妊娠结局没有显著的相关性。因此AMH水平可能不是卵母细胞质量的评价指标。

Objective To investigate the effect of anti-Müllerian hormone(AMH)level on early pregnancy loss and cumulative pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI),and whether AMH level can be used as an indicator to evaluate the quality of oocytes.Methods A retrospective cohort analysis was performed on 3701 women undergoing their first oocyte retrieval for IVF/ICSI at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from December 2015 to December 2019.According to the age,patients were divided into elderly group(≥35 years old)and younger group(<35 years old).References to the Bologna criteria and POSEIDON criteria,patients were divided into three groups:low AMH group(AMH≤1μg/L),moderately low AMH group(1μg/L<AMH<2μg/L),normal AMH group(2μg/L≤AMH<6μg/L).The basic data and clinical data,the differences of early pregnancy loss,cumulative pregnancy rate and cumulative live birth rate among each group were compared.Binary logistic regression was used to analyze the effect of AMH on pregnancy outcome by control confounders(such as age,infertility reason,stimulation protocol,endometrial thickness on the day of human chorionic gonadotropin injection,basic follicle-stimulating hormone level).Results There were no significant differences in clinical pregnancy rate,live birth rate and early pregnancy loss rate among the three groups(all P>0.05)whether in the elderly group or the younger group.The cumulative pregnancy rates were 61.9%(211/341),66.0%(319/483),69.3%(1219/1760),and the cumulative live birth rates were 50.1%(171/341),57.8%(279/483),57.1%(1005/1760)in low AMH group,moderately low AMH group and normal AMH group of the younger group,respectively,and there were statistical differences(P=0.020,P=0.047).After adjusting for confounding factors,in the younger group,cumulative pregnancy rate and cumulative live birth rate in the low AMH group were lower than those in the normal AMH group(OR=0.617,95%CI=0.460-0.829,P=0.001;OR=0.660,95%CI=0.496-0.878,P=0.004),the cumulative pregnancy rate and the cumulative live birth rate in the moderately low AMH group were lower than those in the normal AMH group,but there was no statistical difference(all P>0.05).There were no significant differences in cumulative pregnancy rate and cumulative live birth rate among the three groups with different AMH levels in the elderly group(all P>0.05).Conclusion AMH is not associated with the incidence of early pregnancy loss during the their first oocyte retrieval in IVF/ICSI.AMH level is an independent factor affecting the cumulative pregnancy outcome in the younger group,the pregnancy outcome of women with AMH≤1μg/L decreased significantly.In the eldly women,AMH was not significantly associated with cumulative pregnancy outcome.AMH level may not be an indicator of oocyte quality.