Association between Metal(loid)Exposure and Risk of Polycystic Ovary Syndrome Mediated by Anti-Müllerian Hormone among Women Undergoing In Vitro Fertilization and Embryo Transfer

Objective To investigate the relationship and potential pathways between metal(loid)exposure and the risk of polycystic ovary syndrome(PCOS)in women of childbearing age.Methods This case-control study included 200 patients with PCOS(cases)and 896 non-PCOS controls with the age of 25-37 years.The concentrations of 29 metal(loid)s in the follicular fluid(FF)and clinical indicators in the serum were measured in all participants.Logistic regression analysis and mediation analysis were conducted to evaluate the associations between metal(loid)exposure and PCOS risk and investigate the possible roles of clinical indicators,respectively.Results Logistic regression analysis revealed an association between high copper levels in FF and increased PCOS risk(highest vs.lowest quartile:adjusted odds ratio=2.94,95%confidence interval:1.83-4.72).A high luteinizing hormone/follicle-stimulating hormone ratio and elevated levels of testosterone and anti-Müllerian hormone(AMH)were strongly associated with increased PCOS risk induced by high copper exposure.The mediation analysis indicated a mediating effect of AMH in the association between copper exposure and PCOS risk.Conclusion Copper may affect PCOS risk through the hypothalamic-pituitary-ovarian axis,mediated by AMH.Copper exposure and internal AMH levels are important indicators for early warning of PCOS development.

Seminal plasma anti-Müllerian hormone level correlates with semen parameters but does not predict success of testicular sperm extraction （TESE）

Aim： To assess seminal plasma anti-Müllerian hormone （AMH） level relationships in fertile and infertile males. Methods： Eighty-four male cases were studied and divided into four groups： fertile normozoospermia （n = 16）, oligoastheno- teratozoospermia （n = 15）, obstructive azoospermia （OA） （n = 13） and non-obstructive azoospermia （NOA） （n = 40）. Conventional semen analysis was done for all cases. Testicular biopsy was done with histopathology and fresh tissue examination for testicular sperm extraction （TESE） in NOA cases. NOA group was subdivided according to TESE results into unsuccessful TESE （n = 19） and successful TESE （n = 21）. Seminal plasma AMH was estimated by enzyme linked immunosorbent assay （ELISA） and serum follicular stimulating hormone （FSH） was estimated in NOA cases only by radioimmunoassay （RIA）. Results： Mean seminal AMH was significantly higher in fertile group than in oligoasthenoteratozoospermia with significance （41.5±10.9 pmol/L vs. 30.5±10.3 pmol/L, P 〈 0.05）. Seminal AMH was not detected in any OA patients. Seminal AMH wascorrelated positively with testicular volume （r = 0.329, P = 0.005）, sperm count （r = 0.483, P = 0.007）, sperm motility percent （r = 0.419, P = 0.021） and negatively with sperm abnormal forms percent （r = -0.413, p = 0.023）. Nonsignificant correlation was evident with age （r = -0.155, P = 0.414） and plasma FSH （ r = -0.014, P = 0.943）. In NOA cases, seminal AMH was detectable in 23/40 cases, 14 of them were successful TESE （57.5%） and was undetectable in 17/40 cases, 10 of them were unsuccessful TESE （58.2%）. Conclusion： Seminal plasma AMH is an absolute testicular marker being absent in all OA cases. However, seminal AMH has a poor predictability for successful testicular sperm retrieval in NOA cases.

Anti-Müllerian hormone and antral follicle count predict ovarian response in women less than 45 years following GnRH antagonist multiple-dose protocol

Objective:To speculate which of the following parameters:antral follicle count(AFC),anti-Müllerian hormone(AMH),follicle-stimulating hormone(FSH)and age can be used as a predictor of ovarian response to gonadotropin-releasing hormone(GnRH)antagonist stimulation multiple-dose protocol in women under 45 years,and to determine the cutoff value of these parameters and their correlations for predicting low and high ovarian response.Methods:This prospective study included 462 women with the mean age of(29.3±6.5)years.All women were subjected to the GnRH antagonist stimulation multiple-dose protocol.On the second day of the menstrual cycle,ultrasonography was conducted to determine AFC in both ovaries.Peripheral blood samples were collected to evaluate the level of estradiol,FSH,luteinizing hormone,prolactin,thyroid-stimulating hormone,and AMH.The women were divided into three groups:low response(AHH<1 ng/mL,n=173),normal response(AMH=1.0-3.5 ng/mL,n=175),and high response(AMH>3.5 ng/mL,n=114).Results:A significant decrease was found in the age and FSH level in the high response group compared to other groups(P<0.001).Conversely,a significant increase was shown in AMH,estradiol on human chorionic gonadotropin(hCG)day,AFC,mature oocytes,fertilized oocytes,and embryos transferred in the high response group compared to the other two groups(P<0.001).The receiver operating characteristic(ROC)curves demonstrated that AFC and AMH had the highest accuracy,followed by basal FSH level and age in the prediction of low ovarian reserves(P<0.001)with cutoff values of≤4.50 and≤0.95 for AFC and AMH,respectively.Moreover,the ROC analysis showed that AFC had the highest accuracy,followed by AMH level and age in the prediction of high ovarian reserves with a cutoff value of≥14.50,≥3.63,and≤27.50 years,respectively(P<0.01).A significant decrease was observed in women's age,estradiol level,and oocyte fertilization rate in pregnant women compared to non-pregnant women(P<0.001).Additionally,significant negative correlations were found between the AFC,the number of mature oocytes,fertilized oocytes,embryos transferred,and the age of pregnant women(P<0.001).Conclusions:AFC and AMH predict low and high ovarian response to GnRH antagonist stimulation multiple-dose protocol in women under 45 years.

Association between anti-Müllerian hormone concentrations and sperm retrieval outcomes in patients with idiopathic nonobstructive azoospermia:a systematic review and meta-analysis

Microdissection testicular sperm extraction(mTESE)is commonly performed to retrieve sperm in the testes for assisted reproductive techniques in patients with idiopathic nonobstructive azoospermia(iNOA).However,the success rate of sperm retrieval varies among individuals.We aim to investigate the association between clinical parameters and sperm retrieval outcomes in patients with iNOA.We searched PubMed,EMBASE,and Web of Science from database inception to August 2,2023.The main measure was whether sperm retrieval was successful in patients with iNOA who underwent mTESE.Pooled estimates of the sperm retrieval rate and weighted mean differences were calculated using random-effects models.The overall sperm retrieval rate was 36.8%(95%confidence interval[CI]:27.5%-46.0%,I 2=95.0%)in nine studies comprising 1892 patients with iNOA.No significant differences were found in age,testicular volume,serum total testosterone concentrations,or inhibin B concentrations between positive and negative sperm retrieval outcomes.Lower anti-Müllerian hormone concentrations in patients with iNOA were associated with a positive outcome of mTESE(weighted mean differences:−2.70;95%CI:−3.94-−1.46,I 2=79.0%).In conclusion,this study shows a significant relationship between anti-Müllerian hormone and sperm retrieval outcomes in patients with iNOA,while age,testicular volume,total testosterone,and inhibin B show no significant association.These findings have important implications for assessing the potential success of sperm retrieval and selecting appropriate treatment strategies in patients with iNOA.

Evaluation of Serum Anti-Müllerian Hormone (AMH) Values for 28,016 Bulgarian Women: Prognostic Statistical Model of Age Specific AMH Declining

The present study aims to establish a relationship between serum AMH levels and age in a large group of women living in Bulgaria, as well as to establish reference age-specific AMH levels in women that would serve as an initial estimate of ovarian age. A total of 28,016 women on the territory of the Republic of Bulgaria were tested for serum AMH levels with a median age of 37.0 years (interquartile range 32.0 to 41.0). For women aged 20 - 29 years, the Bulgarian population has relatively high median levels of AMH, similar to women of Asian origin. For women aged 30 - 34 years, our results are comparable to those of women living in Western Europe. For women aged 35 - 39 years, our results are comparable to those of women living in the territory of India and Kenya. For women aged 40 - 44 years, our results were lower than those for women from the Western European and Chinese populations, close to the Indian and higher than Korean and Kenya populations, respectively. Our results for women of Bulgarian origin are also comparable to US Latina women at age 30, 35 and 40 ages. On the base on constructed a statistical model to predicting the decline in AMH levels at different ages, we found non-linear structure of AMH decline for the low AMH 3.5) the dependence of the decline of AMH on age was confirmed as linear. In conclusion, we evaluated the serum level of AMH in Bulgarian women and established age-specific AMH percentile reference values based on a large representative sample. We have developed a prognostic statistical model that can facilitate the application of AMH in clinical practice and the prediction of reproductive capacity and population health.

Anti-Müllerian Hormone and Its Utility in Cattle Reproduction

Reproductive biotechnologies offer us greater possibilities to improve animal genetics. However, the success of these depends on different factors such as the proper selection of the donor female. For this reason, endocrine markers have been used to evaluate the ovarian reserve, which allow a successful selection of donors. Recent research has shown, among other things, that concentrations greater than 0.130 ng/mL of anti-Mullerian hormone (also known as Muller-inhibiting substance, which is a member of the transforming growth factor beta superfamily of growth and differentiation factors) are related to donors of more than fifteen transferable embryos. Therefore, this review describes studies showing that the measurement of anti-Müllerian hormone concentrations, before superovulation programs, reduces the costs per embryo produced.

原发卵巢Müllerian腺肉瘤1例及文献回顾

报道复旦大学附属妇产科医院于2022年收治的原发性卵巢Müllerian腺肉瘤(Müllerian adenosarcoma,MA)1例,并进行文献复习,分享卵巢腺肉瘤的诊治经验。患者,女性,29岁,未婚育,外院行腹腔镜下卵巢病损切除术,术中探查见“右侧卵巢体积增大,下极可见大小约11 cm×8 cm的菜花样肿块,无包膜,质地似鱼肉样,完全切除肿块送检”。术后经北京某(三甲)医院及我院病理科会诊提示卵巢腺肉瘤,遂行全面分期手术:腹腔镜下右侧输卵管卵巢切除术、左侧卵巢囊肿剥除术、大网膜切除术、腹膜多点活检术;宫腔镜下宫颈管占位切除术。术后予紫杉醇+异环磷酰胺化疗4周期。患者化疗结束后定期随访,目前术后近2年随访期间无复发征象。

Potential Application of Anti-Müllerian Hormone in Polycystic Ovary Syndrome According to Chinese Classification Criteria:A Retrospective Analysis

Objective:Anti-Müllerian hormone(AMH)expression is elevated in patients with polycystic ovary syndrome(PCOS),however,its clinical significance is not clear.Owing to the strong correlation between AMH and polycystic ovarian morphology(PCOM),some studies believe that AMH alone can be used to diagnose PCOS.The aim of this study was to explore whether AMH can be used to diagnose PCOS and to differentiate the various PCOS subtypes.Methods:This was a retrospective study of 503 patients with PCOS.Patients were divided into eight subtypes based on the presence/absence of hyperandrogenemia(HA),insulin resistance(IR),or obesity(OB).The expression characteristics of AMH in each subtype were analyzed.Due to the small number of patients with subtypes 7 and 8,only patients with subtypes 1-6 were included in the analysis.Results:AMH showed a good positive correlation with PCOM(P=0.000)and negative correlations with OB(P=0.000)and IR(P=0.003).The free testosterone index showed no correlation with AMH(P=0.803).The percentages of patients with each subtype(excluding subtypes 7-8)and their respective AMH levels were as follows:Type 1(HA+NIR+OB)4.77% and 9.12 ng/mL;Type 2(HA+IR+NOB)20.68% and 10.34 ng/mL;Type 3(HA+NIR+NOB)23.66% and 9.47 ng/mL;Type 4(HA+IR+OB)30.82% and 8.32 ng/mL;Type 5(NHA+NIR+NOB)11.73% and 10.0 ng/mL;and Type 6(NHA+IR+NOB)6.16% and 9.76 ng/mL.The diagnostic rates of AMH(>8.09 ng/mL)and ultrasound for PCOM were 60.10% and 85.60% ,respectively,suggesting that AMH did not completely predict PCOM.Conclusions:High AMH levels can be used to evaluate the incidence trend of PCOS.However,due to clinical heterogeneity,accurately evaluating the severity of PCOS and identifying the subtype of PCOS in Chinese patients are difficult.Individualized treatment should be administered based on accurate clinical subtypes and other clinical characteristics.

Circulating anti-Müllerian hormone as predictor of ovarian response to gonadotrophins in women with polycystic ovary syndrome

Objective To investigate the impact of high circulating anti-Müllerian hormone（AMH）on the outcome of ovulation induction using human menopausal gonadotropin（hM G）in women with polycystic ovary syndrome（PCOS）.Methods This prospective study included 63 anovulatory women with PCOS who underwent hM G ovarian stimulation. Serum AMH concentrations were compared between responders and non-responders. The receiver-operating characteristic（ROC）curve was used to evaluate the prognostic value of circulating AMH.Results hM G responders had a significantly lower serum AMH concentration compared with non-responders（8.43±2.18 μg/L vs 11.05±2.85 μg/L, P〈0.001）. In multivariate Logistic regression analysis, AMH was an independent predictor of ovulation induction by hM G in PCOS patients. ROC curve analysis showed AMH was a useful predictor of ovulation induction by hM G in PCOS patients, having 91.7% specificity and 66.7% sensitivity when the threshold AMH concentration was 10.12 μg/L.Conclusion Serum AMH can be used as an effective parameter to predict ovarian response to hM G treatment in PCOS patients.

Anti-Müllerian hormone, antral follicle count and folliclestimulating hormone for predicting the number of oocytes retrieved in IVF/ICSI cycles

Objective To evaluate the efficacy of anti-Müllerian hormone（AMH）, antral follicle count（AFC） and follicle-stimulating hormone（FSH） for predicting the number of oocytes retrieved in in-vitro fertilization/intracytoplasmic sperm injection（IVF/ICSI）cycles.Methods In this retrospective study, a total of 122 infertile women were divided into two groups： group A, 〈35 years（n=71）; group B, ≥35 years（n=51）. AMH and FSH were determined on 2-5 d of the early menstrual cycle. AFC was tested on the second day of the menstrual cycle before the start of stimulation.Results Group B had higher FSH levels compared with group A（8.2±3.5 IU/L vs 6.8±2.4 IU/L, P〈0.05）. However, levels of AMH and AFC in group B were lower than those of group A（AMH： 4.2±3.5 μg/L vs 2.7±2.7 μg/L; AFC： 9.0±3.9 vs 5.4±3.3, P〈0.05）. The number of oocyte retrieved in the two groups was not significantly different（11.5±6.8 vs 9.6±6.9, P〉0.05）. The level of AMH was more strongly correlated with the number of oocytes retrieved than that of AFC or FSH level. The strengths of the correlation degrees were AMH level, AFC, and FSH level in turn（r=0.600, 0.511,-0.369）.Conclusion AMH would be a useful predictor for ovarian response.

Comparison of body mass index, anti-müllerian hormone and insulin resistance parameters among different phenotypes of polycystic ovary syndrome

Background:Diagnosis of polycystic ovary syndrome(PCOS)depends on 2003 Rotterdam Criteria.According to these criteria there are four possible combinations resulting in various phenotypes.We aimed(i)to confirm that the levels of body mass index(BMI),anti-müllerian hormone(AMH)levels and insulin resistance(IR)are higher in PCOS patients and higher in phenotype-A among PCOS patients,and(ii)to determine cut-off values for the diagnosis of PCOS and phenotype-A.Materials and methods:This study was conducted in an IVF Center,between November 2019 and January 2021.Data of infertile women participating in the study was evaluated retrospectively.Parameters such as menstruation pattern,clinical hyperandrogenism,age,BMI,follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol,thyroid stimulating hormone(TSH),prolactin,AMH,dehydroepiandrosterone sulphate(DHEA-S),fasting blood glucose,fasting insulin levels,antral follicle counts(AFC)and ovarian volumes were recorded for each patient.Women were grouped as PCOS and non-PCOS,and PCOS group was further divided into 4 subgroups according to their phenotypes.Data of infertile patients with PCOS patients were compared with infertile non-PCOS patients and PCOS phenotypes were compared among each other.Results:Data of 244 infertile patients was included in the study.BMI,AMH,AFC,and HOMA-IR were statistically higher in PCOS patients,compared to non-PCOS patients.We found the AMH level of>3.105 ng/ml to be having 90.8%sensitivity and 90%specificity to diagnose a patient as PCOS.Among different phenotypes,also BMI,AMH,and insulin resistance index(HOMA-IR)levels were significantly higher in infertile PCOS phenotype-A when compared to other three phenotypes(p:0.003,p:0.000,and p:0.000,respectively).The AMH cut-off value to estimate phenotype-A was found as 6.095 ng/ml with 69.2%sensitivity and 86.7%specificity.We did not found threshold levels of BMI and HOMA-IR with high sensitivity to identify phenotype-A.Conclusion:Properly diagnosing PCOS and determining the phenotype are crucial due to the long-term health conditions.Therefore,we suggest that serum AMH level could be included in PCOS diagnosis criteria,and the value of 3.105 ng/ml would have a 90.8%sensitivity and 90%specificity.Also,to identify phenotype-A,AMH level could be used.Therefore,we speculate that AMH may serve to identify PCOS and PCOS phenotype-A in places where ultrasound imaging is not straightforward to perform or not easily accessible.

Impact of Systemic Lupus Erythematosus on Ovarian Reserve in Premenopausal Women before Receiving Cyclophosphamide Therapy: Evaluation Using Anti-Müllerian Hormone

Introduction: Anti-Müllerian hormone (AMH) is shown to be a possible indicator of ovarian function. Severe systemic lupus erythematosus (SLE) patients exposed to high-dose cyclophosphamide (CTX) have a much higher risk of developing infertility and premature ovarian failure. Therefore, we performed a prospective case-control study to evaluate the impact of SLE on women’s ovarian reserve using AMH before CTX therapy. Methods: SLE patients before receiving CTX therapy were enrolled in our hospital. Age-matched healthy women were served as controls. Serum AMH level was measured using an enzyme-linked immunosorbent assay. Basal hormone levels were measured including follicle-stimulating hormone, luteinizing hormone, and estradiol on the third day of their menstrual periods. All participants underwent transvaginal ultrasonographic examination for the determination of total antral follicle count on the third day. Results: AMH value in SLE patients was significantly lower compared to healthy control with normal ovarian reserve. No significant difference in AMH levels was found between SLE and healthy control with low ovarian reserve. Conclusions: SLE patients not receiving CTX therapy even with normal menstruation, still had an impaired ovarian reserve. Therefore, early monitoring of AMH levels could better reflect the ovarian function and reproductive outcomes of SLE patients and relative protective strategy needed to reserve fertility.

Association of Genetic Polymorphisms of Anti-Müllerian Hormone (AMH) and Its Type II Receptor with Ovarian Hyperstimulation Syndrome

Objective To explore the association of genetic polymorphisms in the genes encoding the anti-Miillerian hormone （AMH） and its type H receptor （AMHRII） with ovarian hyperstimulation syndrome （OHSS）. Methods Using polymerase chain reaction （PCR） and DNA sequencing techniques, the exons of AMH and AMHRII were analyzed in 27 OHSS patients （OHSS group） and 22 non-OHSS patients （control group） who were applied controlled ovarian hyper- stimulation （COH）. Single nucleotide polymorphisms （SNPs） were also analyzed. Results SNPs G〉 T at position 146 of AMH exon 1 and G〉 A at position 134 of AMH exon 2 showed significant differences between the OHSS group and control group （P〈0.05）. SNP G〉 T at position 303 of AMH exon 1 showed no significant difference between the OHSS group and control group （P〉0.05）. No SNP was detected from the AMHR H exons 1 to 11 in either groups. Conclusion Genetic polymorphisms in the AMH gene may be a cause of ovarian hypersensitivity to exogenous hormone stimulation and the development of OHSS.

AMH联合卵巢超声影像学参数对早发性卵巢功能不全的预测价值

目的 探讨育龄期女性不同年龄的性激素、抗苗勒氏管激素(anti-Müllerian hormone, AMH)水平和卵巢超声影像学参数的变化,分析其对早发性卵巢功能不全(premature ovarian insufficiency, POI)的预测价值并建立预测模型。方法 选择2018年2月至2022年6月就诊于西安交通大学第一附属医院的1 968名育龄期女性为研究对象,检测其性激素、AMH、窦卵泡计数(antral follicle count, AFC)、卵巢总体积、卵巢皮质体积、卵巢髓质体积、卵巢总面积、卵巢皮质面积、卵巢髓质面积,分析不同年龄各项指标的变化及其对POI的预测价值,采用AMH联合卵巢超声影像学参数建立预测POI的模型。结果 1 968名研究对象中POI患病率为3.10%,30~39岁年龄组POI的患病率显著高于20~29岁年龄组(P<0.05)。30~34岁组血清AMH水平显著低于20~24岁组和25~29岁组(P<0.05),35~39岁组血清卵泡刺激素(follicle stimulating hormone, FSH)、黄体生成素(luteinizing hormone, LH)水平显著高于30~34岁组(P<0.05),而血清雌二醇(estradiol, E2)和AMH水平、AFC、卵巢体积、卵巢皮质体积、卵巢面积、卵巢皮质面积均显著低于30~34岁组(P<0.05)。POI组患者的血清FSH、LH水平显著高于同龄女性卵巢功能正常者(P<0.05),而血清E2、AMH水平显著低于同龄女性卵巢功能正常者(P<0.05)。POI组患者的AFC、卵巢体积、卵巢皮质体积、卵巢髓质体积、卵巢面积、卵巢皮质面积和卵巢髓质面积均显著低于同龄女性卵巢功能正常者(P<0.05)。对POI的预测价值分析结果显示,激素水平中AMH的预测价值最高(AUC=0.957),其次为E2(AUC=0.840)。超声影像学参数中AFC的预测价值最高(AUC=0.867),其次为卵巢皮质体积(AUC=0.835)。AMH联合卵巢超声影像学参数建立的模型对POI具有较好的预测价值,其灵敏度为94.86%,特异度为91.23%,AUC为0.960,截断值为12分。结论 育龄期女性中30~39岁年龄组POI的患病率较高,AMH联合卵巢超声影像学参数建立的模型对POI具有一定的预测价值,特别对隐匿期女性获得临床关注。

子宫Müllerian腺肉瘤5例临床病理分析

目的探讨子宫Müllerian腺肉瘤的临床病理学特征。方法收集5例子宫Müllerian腺肉瘤的临床资料,行HE、免疫组化EnVision法染色,分析其临床病理学及免疫表型特征,并复习相关文献。结果5例患者年龄41~63岁,中位年龄44岁。镜下肿瘤呈分叶状结构,富于细胞的间质呈乳头状和息肉状突入囊性扩张的腺腔内或压迫良性腺体呈成角的裂隙。轻~中度异型的间质细胞围绕腺体呈套袖样增生。免疫表型:肿瘤间质细胞ER、PR、SMA均弥漫阳性,腺体周围CD10阳性,Ki-67增殖指数3%~30%。结论子宫Müllerian腺肉瘤常表现为阴道异常出血,多为低度恶性肿瘤,手术治疗为主,不良预后与肿瘤过度生长、脉管内癌栓、FIGO分期等有关。

子宫内膜异位症生育指数联合血清AMH对子宫内膜异位症患者自然妊娠结局的预测价值

目的 探究子宫内膜异位症生育指数(EFI)联合血清抗米勒管激素(AMH)对子宫内膜异位症(EMT)患者自然妊娠结局的预测价值。方法 选择行腹腔镜手术治疗的113例子宫内膜异位症患者作为研究对象,均于术前及术后对其EFI、AMH进行检测,然后随访2年,根据自然妊娠结局将其分为自然妊娠成功组(70例)和自然妊娠失败组(43例)。统计113例患者术后EFI评分及术前、术后AMH水平;比较自然妊娠成功组和自然妊娠失败组的一般资料及术后EFI评分、AMH水平;分析EFI、AMH单独检测及联合检测对子宫内膜异位症患者自然妊娠结局的预测价值。结果 113例子宫内膜异位症患者术后的EFI评分为(5.63±1.38)分;患者术前AMH水平为(2.30±0.64)ng/ml,术后为(4.16±0.59)ng/ml,术后的AMH水平高于术前(P<0.05)。术后随访2年,其中有70例患者自然妊娠成功(自然妊娠成功组),成功率为61.95%;43例自然妊娠失败(自然妊娠失败组),失败率为38.05%。自然妊娠成功组和自然妊娠失败组的年龄、不孕病程、体质量指数、不孕类型比较,无明显差异(P>0.05)。术后,自然妊娠成功组的EFI评分(6.03±0.72)分、AMH水平(4.32±0.55)ng/ml均比自然妊娠失败组的(4.33±1.26)分、(3.89±0.87)ng/ml高(P<0.05)。联合检测的曲线下面积(AUC)为0.902、特异度为97.33%,均比EFI、AMH单独检测的0.816、90.54%及0.802、93.45%高。结论 子宫内膜异位症患者经腹腔镜手术治疗后EFI、AMH水平较高者的自然妊娠成功率更高, EFI、AMH可对自然妊娠结局进行预测,两者联合的预测价值更高。

白藜芦醇提高多囊卵巢综合征大鼠卵巢局部抗氧化水平的研究

目的:探讨白藜芦醇(RSV)对多囊卵巢综合征(PCOS)大鼠卵巢形态、血浆抗苗勒管激素(AMH)、胰岛素样生长因子1(IGF-1)水平及氧化应激参数的影响。方法:采用注射脱氢表雄酮方法构建PCOS大鼠模型,将大鼠分为对照组(n=12)、模型组(n=12)、罗格列酮组(RSG组,n=11)和白藜芦醇组(RSV组,n=11)。RSG组给予3.0 mg/(kg·d)的RSG灌胃,RSV组给予10 mg/(kg·d)的RSV灌胃,模型组和对照组均给予等量生理盐水灌胃,连续用药4周。以光学显微镜观察卵巢组织学,以酶联免疫吸附法检测血浆AMH和IGF-1水平,以Ellman法检测卵巢组织谷胱甘肽过氧化物酶(GSH-Px)活性,以Sun法检测卵巢组织超氧化物歧化酶(SOD)活性,以AEBI法测定卵巢组织过氧化氢酶(CAT)活性。结果:给药4周后,模型组与对照组相比较,上述指标差异均有统计学意义(P<0.05),RSG和RSV组与模型组相比较,上述指标差异均有统计学意义(P<0.05)。结论:RSV可提高PCOS大鼠卵巢局部抗氧化能力,降低IGF-1和AMH水平,改善PCOS大鼠卵巢组织形态,提示其治疗PCOS的潜在价值。

甲状腺自身免疫性抗体与不孕女性卵巢储备功能的关联性研究

目的比较不同卵巢储备功能不孕女性甲状腺自身免疫性抗体阳性率的差异,寻找与卵巢储备功能减退的相关免疫因素。方法采用病例-对照研究设计方案,收集2020年6-12月在北京妇产科医院生殖医学科就诊的不孕患者,检测纳入的526例不孕患者抗苗勒氏管激素(anti-Müllerian hormone,AMH)、促甲状腺素(thyroid stimulating hormone,TSH)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)和甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb);根据AMH水平(>1.1 ng/mL和≤1.1 ng/mL),将患者分为卵巢储备正常组和卵巢储备减退组,并进行年龄分层(25~30岁,>30~35岁,>35~40岁),比较不同卵巢储备患者的TSH、TGAb和TPOAb的差别,分析卵巢储备功能减退降低的关联因素。结果在单因素分析中显示卵巢储备减退组患者的TPOAb(18.8%vs 11.1%,P=0.024)和TGAb(18.8%vs 8.0%,P=0.001)阳性率较高,存在显著性差异。多因素Logistic回归分析提示年龄、TGAb阳性和卵巢储备减退有关联[OR=1.083(95%CI:1.021~1.150),P=0.008;OR=1.159(95%CI:1.034~1.301),P=0.011]。亚组分析显示,在>35~40岁年龄组中,TGAb阳性及TPOAb阳性与AMH分组的存在显著相关性(P<0.05)。结论卵巢储备功能减退的不孕女性TGAb和TPOAb较高,>35~40岁不孕女性的卵巢储备功能减退可能与TGAb及TPOAb阳性相关。

血清抗苗勒管激素水平对不同年龄患者IVF/ICSI临床结局的影响

目的探讨低血清抗苗勒管激素(AMH≤1.1 ng/ml)对不同年龄阶段女性的胚胎质量、临床妊娠率、流产率、活产率及流产胚胎绒毛染色体非整倍性的影响。方法回顾性分析2015年1月至2022年12月于广东省第二人民医院生殖医学中心行IVF/ICSI助孕治疗的患者资料,共纳入20886个取卵周期、17218个胚胎移植周期,以及124例移植后妊娠流产绒毛染色体检查病例。根据AMH水平分为观察组(AMH≤1.1 ng/ml)和对照组(AMH>1.1 ng/ml),并按年龄段分层(年龄≤30岁、30岁<年龄≤35岁、35岁<年龄≤38岁、38岁<年龄≤40岁、年龄>40岁),分析不同年龄段不同AMH组间胚胎质量、妊娠率、活产率、流产率以及流产患者胚胎绒毛染色体检查结果。结果相较于对照组,观察组在各年龄段的正常受精率、D3优胚率、D3可利用胚胎率、囊胚形成率均显著降低(P<0.05),且临床妊娠率和活产率亦显著降低(P<0.05);流产率随着年龄的增加逐渐升高,但仅>40岁患者中观察组流产率显著高于对照组(P<0.05);全部14例>40岁患者的流产胎儿组织染色体均检测出异常。结论AMH和年龄共同影响辅助生殖技术治疗患者的胚胎质量和妊娠结局。

卵巢早衰及不同亚型多囊卵巢综合征患者的AMH、性激素水平检测

目的 探讨卵巢早衰及不同亚型多囊卵巢综合征患者抗苗勒管激素(AMH)、性激素水平检测的意义。方法 选取2020年7月至2021年7月我院收治的30例卵巢早衰患者为早衰组,70例多囊卵巢综合征患者为多囊组;同期选取50名健康体检妇女为对照组。多囊组根据不同亚型分为稀发排卵或无排卵(OA)+高雄激素临床表现或高雄激素血症(HA)+卵巢多囊样改变(PCO)组17例,OA+HA组20例,OA+PCO组18例,HA+PCO组15例。比较各组的AMH、性激素水平。结果 早衰组的AMH、雌二醇(E_2)水平低于对照组,促卵泡激素(FSH)、黄体生成素(LH)、睾酮(T)水平高于对照组(P<0.05);多囊组的AMH、E_2、LH、T水平高于对照组,差异具有统计学意义(P<0.05)。不同亚型多囊卵巢综合征患者的AMH、LH、T水平比较,差异具有统计学意义(P<0.05)。70例多囊卵巢综合征患者中,成功妊娠至分娩25例,未成功妊娠或流产45例;不同妊娠结局多囊卵巢综合征患者的AMH、E_2、FSH、LH、T水平比较,差异无统计学意义(P>0.05)。30例卵巢早衰患者中,成功妊娠至分娩4例,未成功妊娠或流产26例;成功妊娠至分娩患者的AMH、E_2水平高于未成功妊娠或流产患者,LH、T水平低于未成功妊娠或流产患者(P<0.05)。结论 卵巢早衰及不同亚型多囊卵巢综合征患者的AMH、性激素水平有所差异;AMH、性激素水平能反映患者卵巢功能情况,对卵巢早衰及不同亚型多囊卵巢综合征患者卵巢功能有较好的评估价值,但与多囊卵巢综合征患者妊娠情况无明显关系,与卵巢早衰患者妊娠期情况有一定联系,值得推广。