生殖医学杂志

目的 分析术前不同血清抗苗勒管激素(AMH)水平与卵巢子宫内膜异位症囊肿合并不孕患者术后妊娠结局的关联，并了解术前卵巢储备功能低者的生育结局。方法 回顾性分析2020年1月至2021年12月期间，在北京协和医院妇产科因卵巢子宫内膜异位症囊肿合并不孕并接受腹腔镜囊肿剔除的79例患者的临床资料，电话随访生育结局至2022年7月。按照术前AMH水平进行分组，比较各组间的妊娠率和活产率等。结果 至随访截止，79例卵巢子宫内膜异位症囊肿合并不孕患者术后总妊娠率48.1%(38/79),总活产率22.8%(18/79)。以AMH 1.1 ng/ml为界值分组分析，卵巢储备功能减退(DOR;AMH<1.1 ng/ml组)病例占比20.3%(16/79),其妊娠率(25.0%vs. 54.0%,P<0.05)和活产率(6.3%vs. 27.0%,P<0.05)均显著低于非DOR患者(AMH>1.1 ng/ml组),其中AMH≤0.5 ng/ml的患者中无一例妊娠；以AMH 2.0 ng/ml为界值分组分析，AMH≤2.0 ng/ml组患者妊娠率(27.8%vs. 65.1%,P<0.05)和活产率(8.3%vs. 34.9%,P<0.05)也均显著低于AMH>2.0 ng/ml组。AMH>2.0 ng/ml的病例中，AMH>2.0～3.0 ng/ml组的妊娠率和活产率最高(分别是75.0%和43.8%),而更高AMH水平组妊娠率随AMH基线升高趋于下降。AMH>1.1～2.0 ng/ml组和AMH>0.5～1.1 ng/ml组两组比较，在年龄、病变程度、子宫内膜异位症生育指数(EFI)无显著性差异的情况下，妊娠率(30.0%vs. 50.0%,P>0.05)和活产率(12.5%vs. 10.0%,P>0.05)并无统计学差异，且从数值上看后组似乎结局更优些。结论 术前AMH水平对于卵巢子宫内膜异位症囊肿合并不孕患者术后妊娠可能性的预测有一定指导作用，但并不全面、准确；部分DOR患者仍有值得期待的妊娠结局。

Objective:To investigate the association of different preoperative anti-Müllerian hormone(AMH) levels with postoperative pregnancy outcomes in infertile patients with ovarian endometriosis cysts, and to explore postoperative fertility outcomes in those with low preoperative ovarian reserves.Methods:The clinical data of 79 infertile patients with ovarian endometrioma who underwent laparoscopic surgery in Peking Union Medical College Hospital from January 2020 and December 2021 were retrospectively analyzed. The pregnancy outcomes of the patients were followed-up by telephone till July 2022. The patients were divided into the groups according to the preoperative AMH levels, and the pregnancy rate and live birth rate were compared between groups.Results:As of follow-up, the total postoperative pregnancy rate of 79 infertile patients with ovarian endometriosis cysts was 48.1%(38/79),and overall live birth rate was 22.8%(18/79). With the cut-off value of AMH<1.1 ng/ml, the incidence of diminished ovarian reserve(DOR,AMH<1.1 ng/ml) was 20.3%(16/79),and their pregnancy rate(25.0% vs. 54.0%,P<0.05) and live birth rate(6.3% vs. 27.0%,P<0.05) were significantly lower than those of the non-DOR patients(AMH>1.1 ng/ml). There was no pregnancy in the patients with AMH≤0.5 ng/ml. With the cut-off value of AMH<2.0 ng/ml, the pregnancy rate(27.8% vs. 65.1%,P<0.05) and live birth rate(8.3% vs. 34.9%,P<0.05) in patients with AMH≤2.0 ng/ml were also significantly lower than those in the patients with AMH>2.0 ng/ml. In patients with AMH>2.0 ng/ml, the pregnancy rate and live birth rate were highest in the patients with AMH>2.0-3.0 ng/ml(75.0% and 43.8%,respectively),while the pregnancy rate of the patients with higher AMH levels tended to decrease as AMH baseline increased. There were no significant differences in postoperative pregnancy rate(30.0% vs. 50.0%,P>0.05) and live birth rate(12.5% vs. 10.0%,P>0.05) between the AMH>1.1-2.0 ng/ml group and the AMH>0.5-1.1 ng/ml group on the basis of comparability of age, degree of lesions and endometriosis fertility index(EFI),while the latter group seemed to have a more favorable outcome.Conclusions:Preoperative AMH levels have a guiding role in predicting the outcome of postoperative pregnancy in infertile patients with ovarian endometrioma, but it is not comprehensive or accurate. Some patients with DOR still have a promising pregnancy outcome.