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目的探讨血清抗苗勒氏管激素水平(AMH)在辅助生殖超排卵周期中预测卵巢反应性的价值。方法按获卵数及人绒毛膜促性腺激素(hCG)注射日雌二醇(E2)水平,将68例接受体外受精-胚胎移植(IVF-ET)/体外受精-胞浆内单精子注射(ICSI)的不孕症患者分为卵巢低反应组(A组)、卵巢正常反应组(B组)及卵巢高反应组(C组)。于促排周期月经第2天及hCG注射日,分别检测血清AMH、E2及孕酮(P)水平。比较3组临床效果及注射rFSH后AMH、E2、黄体生成素(LH)及P水平的变化。按妊娠结局分为妊娠组和非妊娠组,比较AMH、窦卵泡数(AFC)、优质胚胎率、优质胚胎数的变化。结果①A、B、C 3组月经第2天(D2)AMH水平的M分别为0.645、1.762及3.101 ng/mL;IVF周期hCG日AMH水平M分别为0.331、0.898及1.434 ng/mL,3组比较差异有统计学意义(P<0.001);多重比较后均发现D2AMH及hCG日AMH差异有统计学意义(P<0.001)(C组>B组>A组)。②获卵数与促排周期D2AMH、hCG日AMH、AFC(窦卵泡数)、P呈显著正相关;与促排周期D2卵泡刺激(FSH)、促性腺激素(GN)量呈负相关。③卵巢过度刺激综合征(OHSS)的发生和GN量、AFC、D2AMH、HCG日E2及HCG日AMH水平均成正相关;与D2FSH成负相关。④妊娠组和未妊娠组间的卵裂率、优胚率及优质胚胎数间有差异性(P<0.05)。结论①D2AMH、hCG日的AMH水平及AFC均是预测卵巢反应性较好的标记物;②D2AMH、hCG日AMH及hCG日E2水平对预测OHSS的发生具有一定的指导意义;③AMH水平不能预测妊娠结局。
Objective To investigate the value of serum anti-Müllerian hormone (AMH) in predicting ovarian response during assisted reproductive superovulation. Methods According to the number of oocytes retrieved and the level of estradiol (E2) on the day of human chorionic gonadotropin (hCG) injection, 68 patients undergoing in vitro fertilization-embryo transfer (IVF-ET) / in vitro fertilization-intracytoplasmic sperm injection ICSI) were divided into low ovarian response group (A group), normal ovarian response group (B group) and high ovarian response group (C group). The level of serum AMH, E2 and progesterone (P) were detected on the second day of menstruation and the day of hCG injection respectively. The clinical effects and the changes of AMH, E2, LH and P after rFSH were compared. According to the pregnancy outcome was divided into pregnancy group and non-pregnancy group, compared AMH, antral follicle number (AFC), high-quality embryos, high-quality embryos changes. Results ① The AMH levels on the second day (D2) of groups A, B and C were 0.645, 1.762 and 3.101 ng / mL, respectively. The AMH levels M on M, F and IVF cycles were 0.331, 0.898 and 1.434 ng / (P <0.001). After multiple comparisons, the differences of AMH between D2AMH and hCG days were found statistically significant (P <0.001) (C group> B group> A group). ② The number of oocytes was significantly positively correlated with D2AMH, hCG AMH, AFC (antral follicle count) and P, but negatively correlated with D2 follicle stimulation (FSH) and gonadotropin (GN). ③ The occurrence of ovarian hyperstimulation syndrome (OHSS) is positively correlated with the amount of GN, AFC, D2AMH, E2 and HCG AMH levels on the HCG day, and negatively correlated with D2FSH. ④ The cleavage rate, excellent embryo rate and the number of high quality embryos between pregnant and nonpregnant groups were different (P <0.05). Conclusion ① The levels of AMH and the AFC of D2AMH and hCG are both good markers for predicting ovarian response. ② The levels of AMH and hCG E2 on D2AMH and hCG days are helpful for predicting the occurrence of OHSS. ③ The level of AMH can not predict the outcome of pregnancy.