| 219 | 13 | 66 |
| 下载次数 | 被引频次 | 阅读次数 |
目的探讨血清抗苗勒管激素水平(AMH)与IVF-ET助孕结局的关系及AMH对临床妊娠率的预测价值。方法回顾性分析2015年10月至2017年10月在浙江省人民医院行IVF-ET助孕的551例不孕患者(共987个周期)的临床资料。根据血清AMH水平,将患者分为高AMH组(AMH≥7ng/ml,43个周期)、中AMH组(1ng/ml≤AMH<7ng/ml,527个周期)及低AMH组(AMH<1ng/ml,417个周期)。根据患者年龄分为A组:<34岁,446个周期;B组:34～<38岁,209个周期;C组:38～<42岁,150个周期;D组:≥42岁,182个周期。并根据是否获得临床妊娠,各组中再分为妊娠组和非妊娠组两个亚组。比较各组间的促排卵情况及妊娠结局,分析不同AMH水平组中及不同年龄组中妊娠组和非妊娠组的AMH水平及年龄是否存在差异。结果不同AMH水平组间的Gn总量、MⅡ卵数、优质胚胎数、可移植胚胎数及取卵周期数比较均有显著性差异(P<0.05);低AMH组的累计临床妊娠率显著低于中AMH组和高AMH组(P<0.05),中AMH组和高AMH组间比较无显著性差异(P>0.05)。不同年龄组间随着年龄的增加,临床妊娠率显著降低,取卵周期数显著增加(P<0.05)。相同AMH水平组内,妊娠组与非妊娠组血清AMH水平比较无显著性差异(P>0.05);但整体分析,妊娠组血清AMH水平显著高于非妊娠组(P<0.05);低AMH组和中AMH组中妊娠组和非妊娠组年龄比较均有显著性差异(P<0.05)。同一年龄组中妊娠组和非妊娠组年龄比较无显著性差异(P>0.05),但AMH水平比较均具有显著性差异(P<0.05)。42岁以上高龄不孕患者,妊娠率为4.65%。结论血清AMH水平能够较好地预测卵巢反应性,但单独预测临床妊娠率的价值有限,需结合年龄因素综合考虑。
Abstract：[1] Nelson SM,Anderson RA,Broekmans FJ,et al.AntiMullerian hormone:clairvoyance or crystal clear?[J].Hum Reprod,2012,27:631-636.
[2] Honnma H,Baba T,Sasaki M,et al.Serum anti-Mullerian hormone levels affect the rate of ongoing pregnancy after in vitro fertilization[J].Reprod Sci,2013,20:51-59.
[3] Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology.The Istanbul consensus workshop on embryo assessment:proceedings of an expert meeting[J].Hum Reprod,2011,26:1270-1283.
[4] Wang JG,Douglas NC,Nakhuda GS,et al.The association between anti-Mullerian hormone and IVF pregnancy outcomes is influenced by age[J/OL].Reprod Biomed Online,2010,21:757-761.
[5] Goswami M,Nikolaou D.Is AMH level,independent of age,a predictor of live birth in IVF?[J].J Hum Reprod Sci,2017,10:24-30.
[6] Nelson SM,Yates RW,Fleming R.Serum anti-Müllerian hormone and FSH:prediction of live birth and extremes of response in stimulated cycle-implications for individualization of therapy[J].Hum Reprod,2007,22:2414-2421.
[7] Lekamge DN,Barry M,Kolo M,et al.Anti-Müllerian hormone as a predictor of IVF outcome[J/OL].Reprod Biomed Online,2007,14:602-610.
[8] Nelson SM,Yates RW,Lyall H,et al.Anti-Müllerian hormone-based approach to controlled ovarian stimulation for assisted conception[J].Hum Reprod,2009,24:867-875.
[9] Merhi Z,Zapantis A,Berger DS,et al.Determining an antiMullerian hormone cutoff level to predict clinical pregnancy following in vitro fertilization in women with severely diminished ovarian reserve[J].J Assist Reprod Genet,2013,30:1361-1365.
[10] Revelli A,Biasoni V,Gennarelli G,et al.IVF results in patients with very low serum AMH are significantly affected by chronological age[J].J Assist Reprod Genet,2016,33:603-609.
[11] van Loendersloot LL,van Wely M,Limpens J,et al.Predictive factors in in vitro fertilizatiton(IVF):a systematic review and meta-analysis[J].Hum Reprod Update,2010,16:577-589.
[12] Anckaert E,Smitz J,Schiettecatte J,et al.The value of antiMüllerian hormone measurement in the long GnRH agonist protocol:association with ovarian response and gonadotrophindose adjustments[J].Hum Reprod,2012,27:1829-1839.
[13] Seifer DB,Maclaughlin DT.Mullerian inhibiting substance is an ovarian growth factor of emerging clinical significance[J].Fertil Steril,2007,88:539-546.
[14] Zheng H,Chen S,Du H,et al.Ovarian response prediction in controlled ovarian stimulation for IVF using anti-Müllerian hormone in chinese women:A retrospective cohort study[J].Medicine(Baltimore),2017,96:e6495.
[15] Eldar-Geva T,Ben-Chetrit A,Spitz IM,et al.Dynamic assays of inhibin B,anti-Mullerian hormone and estradiol following FSH stimulation and ovarian ultrasonography as predictors of IVF outcome[J].Hum Reprod,2005,20:3178-3183.
[16] Chen Y,Ye B,Yang X,et al.Predicting the outcome of different protocols of in vitro fertilization with antiMuüllerian hormone levels in patients with polycystic ovary syndrome[J].J Int Med Res,2017,45:1138-1147.
[17]王馥新,杨辰,吴惠华,等.血清抗苗勒氏管激素在体外受精超排卵中预测卵巢反应的价值[J].生殖医学杂志,2013,22:652-657.
[18]黄佳语,高颖.AMH与卵巢储备功能及体外胚胎发育潜能的关系[J].生殖医学杂志,2017,26:82-86.
基本信息:
中图分类号:R714.8
引用信息:
[1]张焕焕,舒静.血清抗苗勒管激素水平与IVF-ET助孕结局的关系[J].生殖医学杂志,2018,27(12):1238-1242.
基金信息:
浙江省自然科学基金(LY17H040014)
2018-12-11
2018-12-11