生殖医学杂志

目的 分析多囊卵巢综合征(PCOS)相关不孕患者血清抗苗勒管激素(AMH)水平与体外受精-胚胎移植(IVF-ET)周期胚胎发育及妊娠结局的相关性。方法 回顾性分析2020年1月至2024年10月于我院生殖医学科行IVF-ET治疗的610例PCOS伴不孕患者的临床资料，根据患者是否临床妊娠，分为妊娠组(n=468)和未妊娠组(n=142)。比较两组患者的临床资料，应用Spearman秩相关分析血清AMH水平与第3天(D3)优质胚胎、D5优质囊胚的相关性，应用Logistic回归分析PCOS不孕患者未临床妊娠的影响因素，应用平滑曲线拟合分析血清AMH水平与PCOS伴不孕患者未临床妊娠的相关性，应用受试者工作特征(ROC)曲线分析血清AMH水平预测PCOS伴不孕患者未临床妊娠的价值。结果 本研究中，PCOS伴不孕患者临床妊娠率为76.72%。未妊娠组的体质量指数(BMI)、基础黄体生成素(LH)、催乳素(PRL)、AMH水平显著高于妊娠组(P<0.05),基础卵泡刺激素(FSH)水平及D3优质胚胎、D5优质囊胚占比显著低于妊娠组(P<0.05)。BMI、基础LH、AMH水平升高是PCOS伴不孕患者未临床妊娠的独立危险因素(P<0.05);将BMI、基础LH水平调整后，血清AMH水平升高仍是PCOS伴不孕患者未临床妊娠的独立危险因素(P<0.05);患者血清AMH水平与优质胚胎无明显相关性(P>0.05)。平滑曲线拟合分析显示，血清AMH水平与PCOS伴不孕患者未临床妊娠风险呈“J”形非线性关系，当血清AMH<8.4 ng/ml时，PCOS伴不孕患者未临床妊娠风险不受其水平升高的影响[β=0.076,95%CI(-0.526,0.678),P>0.05];当血清AMH≥8.4 ng/ml时，PCOS伴不孕患者未临床妊娠风险随着其水平升高呈上升趋势[β=0.049,95%CI(0.007,0.091),P<0.05];血清AMH水平预测PCOS伴不孕患者未临床妊娠的ROC曲线下面积(AUC)为0.776[95%CI(0.741,0.808)],预测敏感度、特异度分别为76.76%、65.17%。结论 血清AMH水平升高是PCOS伴不孕患者未临床妊娠的独立危险因素，血清AMH≥8.4 ng/ml可作为患者未临床妊娠的预测节点。

Objectives:To analyze the correlation between serum anti-Müllerian hormone(AMH) levels and embryonic development and pregnancy outcomes in in vitro fertilization-embryo transfer(IVF-ET) cycles among infertile patients with polycystic ovary syndrome(PCOS).Methods:A total of 610 infertile patients with PCOS who underwent IVF-ET at Center for Reproductive Medicine of Nanjing Drum Tower Hospital from January 2020 to October 2024 were selected. Based on whether clinically pregnant or not, the patients were divided into pregnant group(n=468) and non-pregnant group(n=142). The clinical data of the two groups were compared, and Spearman's correlation was used to analyze the relationship between serum AMH level and high-quality embryos on day 3(D3) and high-quality blastocysts on day 5(D5). Logistic regression analysis was used to analyze the influencing factors of non-clinical pregnancy. Smooth curve fitting was used to analyze the correlation between serum AMH level and the risk of non-clinical pregnancy in PCOS patients with infertility. Receiver operating characteristic(ROC) curve was used to analyze the value of serum AMH level in predicting non-clinical pregnancy in PCOS patients with infertility.Results:The clinical pregnancy rate of PCOS patients with infertility was 76.72%. The body mass index(BMI),basal serum luteinizing hormone(LH),prolactin(PRL),and AMH levels in the non-pregnant group were higher than those in the pregnant group(P<0.05),the basic serum follicle stimulating hormone(FSH) level and the proportion of D3 high-quality embryos and D5 high-quality blastocysts were lower than those in the pregnancy group(P<0.05). Elevated BMI,basal serum LH and AMH levels were independent risk factors for non-clinical pregnancy in PCOS patients with infertility(P<0.05). After adjusting BMI and basal serum LH,elevated basal serum AMH level was still an independent risk factor for non-clinical pregnancy in PCOS patients with infertility(P<0.05). There was no significant correlation between the AMH level in peripheral blood and the high-quality embryos(P>0.05). Smooth curve fitting analysis showed that there was a ‘J'-shaped non-linear relationship between serum AMH level and the risk of non-clinical pregnancy in PCOS patients with infertility. When serum AMH level <8.4 ng/ml, the risk of non-clinical pregnancy in PCOS patients with infertility was not affected by the increase of serum AMH level [β=0.076,95%CI(-0.526,0.678),P>0.05]. When serum AMH level ≥8.4 ng/ml, the risk of non-clinical pregnancy in PCOS patients with infertility increased with the increase of its level [β=0.049,95%CI(0.007,0.091),P<0.05]. The area under the curve(AUC) of serum AMH in predicting non-clinical pregnancy in PCOS patients with infertility was 0.776 [95%CI(0.741,0.808)],with the sensitivity and specificity were 76.76% and 65.17%,respectively.Conclusions:Elevated serum AMH level is an independent risk factors for non-clinical pregnancy in PCOS patients with infertility. Serum AMH level ≥8.4 ng/ml can be used as a predictive node for non-clinical pregnancy.