30~44岁不孕女性IVF/ICSI中优胚数与AMH的关系分析

Relationship between the number of optimal embryos and AMH in IVF/ICSI of infertile women aged 30 to 44 years old

目的分析30~44岁不孕女性血清抗苗勒管激素(anti-Müllerian hormone,AMH)浓度与第一个体外受精/卵胞浆内单精子注射(in vitro fertilization,IVF/intracytoplasmic sperm injection,ICSI)周期获得的优胚数之间的关联,探索AMH对胚胎发育结局的影响。方法回顾性分析2019年1月至2020年12月于南通大学附属医院生殖医学中心接受IVF/ICSI治疗的患者305周期的临床资料,收集患者的基本特征、临床用药和周期结局,分析AMH与优胚数之间的关联性。结果本研究建立了3种模型来分析AMH与优胚数之间的关联性。在调整了混杂因素[女方年龄、AFC和控制性促排卵方案(controlled ovarian hyperstimulation,COH)]后,AMH每增加1个单位,优胚数增加0.3个单位(95%CI:0.2-0.4,P<0.001)。将AMH按临床截点(0.7 ng/mL和8.5 ng/mL)分为3组进行敏感分析,结果显示与低AMH组(<0.7 ng/mL)相比,高AMH组(≥8.5 ng/mL)每增加1个单位,优胚数增加2.2个单位(95%CI:0.8-3.7,P=0.003)。广义相加模型(GAM)显示AMH与优胚数之间的关系是非线性的。分段回归模型结果显示拐点为AMH=7.1 ng/mL,拐点两侧的效应值、95%CI和P值分别为0.5(0.3-0.7),0.001和0.1(-0.1-0.2),0.518。分层分析和交互作用检验结果显示AMH和优胚数的关系在不同亚组间是稳定的(P>0.05)。结论AMH与IVF/ICSI中优胚数的关系是非线性的,当AMH<7.1 ng/mL时,AMH与优胚数呈正相关。与年龄相关的卵巢储备生物标志物AMH对生殖预后的影响可为临床治疗提供参考。

Objective To explore the effect of serum anti-Müllerian hormone(AMH)on the outcome of embryo development by analyzing the correlation between serum AMH concentration and the number of high-quality embryos obtained in the first in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)cycle in infertile women aged 30~44 years old.Methods Clinical data of 305 cycles of patients who received IVF/ICSI treatment in Reproductive Medicine Center,Affiliated Hospital of Nantong University from January 2019 to December 2020 were retrospectively analyzed.Basic characteristics,clinical medication and cycle outcome of patients were collected,and the correlation between AMH and the number of optimal embryos was analyzed.Results In this study,three models were established to analyze the relationship between AMH and the number of optimal embryos.After adjusting for confounding factors[female age,AFC,and controlled ovarian hyperstimulation(COH)],a one-unit increase in AMH resulted in an increase of 0.3 embryos(95%CI:0.2-0.4,P<0.001).Sensitivity analysis was performed by dividing AMH into three groups according to clinical cut-off points(0.7 ng/mL and 8.5 ng/mL).The results showed that,compared with low AMH group(<0.7 ng/mL),the number of optimal embryos in the high AMH group(≥8.5 ng/mL)increased by 2.2 units for each additional unit(95%CI:0.8-3.7,P=0.003).The generalized additive model(GAM)showed that the relationship between AMH and optimal embryos was nonlinear.The results of piecewise regression model showed that the inflection point was AMH=7.1 ng/mL,and the effect values,95%CI and P values on both sides of the inflection point were 0.5(0.3-0.7),<0.001 and 0.1(-0.1-0.2),0.518,respectively.Stratified analysis and interaction test showed that the relationship between AMH and the number of optimal embryos was stable among different subgroups(P>0.05).Conclusion The relationship between AMH and the number of optimal embryos in IVF/ICSI was non-linear,and when AMH<7.1 ng/mL,AMH was positively correlated with the number of optimal embryos.The effect of age-related ovarian reserve biomarker AMH on reproductive prognosis can provide reference for clinical treatment.