Grzegorczyk-Martin V, Khrouf M, Bringer-Deutsch S, Mayenga J-M, Kulski O, Cohen-Bacrie P, Benaim J-L, Belaisch-Allart J
Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier des 4-Villes, site de Sèvres, 141 Grande-Rue, Sèvres, France.
Gynecol Obstet Fertil. 2012 Jul-Aug;40(7-8):411-8. doi: 10.1016/j.gyobfe.2012.02.001. Epub 2012 Apr 20.
To evaluate the results of controlled ovarian hyperstimulation (COH) for IVF in patients with low anti-Müllerian hormone (AMH) and normal basal follicle stimulating hormone (FSH) and Estradiol levels (≤50 pg/mL).
A retrospective cohort study including 704 patients for whom AMH and FSH levels (measured between days 3 and 5 of the menstrual cycle) were available, is performed in the IVF center at the Sèvres Hospital (France). Three groups are designed and analyzed: group 1 with AMH less or equal to 2 ng/mL and FSH less or equal to 10 mUI/mL (study group), Group 2 with AMH greater than 2 ng/mL and FSH less or equal to 10 mUI/mL (control group) and Group 3 with AMH less or equal to 2 ng/mL and FSH greater than 10 mUI/mL (group with decreased ovarian reserve).
IVF outcome for patients from the study group is significantly worse than that of the second but not than that of the third group. In the first group, the number of retrieved oocytes, the number of total obtained embryos, the clinical pregnancy rate and the live birth rate are significantly lower than in the second group; moreover, there are more cancelled cycles because of poor response in the first group. There is no difference with the third group.
This study shows that women with a low baseline AMH have a similar response to COH to the poor responders patients with a decreased ovarian reserve revealed by an elevated FSH level. Thus, when a woman undergoing IVF cycle presents a low AMH, she might be considered as a poor responder patient regardless of the FSH level and, although the clinical pregnancy rate is not so disappointing (18%), the couple should be informed of a higher risk of cycle cancellation.
评估抗苗勒管激素（AMH）水平低、基础促卵泡生成素（FSH）和雌二醇水平正常（≤50 pg/mL）的患者接受体外受精（IVF）时控制性卵巢刺激（COH）的结果。
在法国瑟夫尔医院的IVF中心进行了一项回顾性队列研究，纳入了704例可获得AMH和FSH水平（在月经周期第3至5天测量）的患者。设计并分析了三组：第1组AMH小于或等于2 ng/mL且FSH小于或等于10 mUI/mL（研究组），第2组AMH大于2 ng/mL且FSH小于或等于10 mUI/mL（对照组），第3组AMH小于或等于2 ng/mL且FSH大于10 mUI/mL（卵巢储备功能下降组）。
研究组患者的IVF结局明显比第二组差，但不比第三组差。在第一组中，回收的卵母细胞数量、获得的胚胎总数、临床妊娠率和活产率均明显低于第二组；此外，第一组因反应不良而取消的周期更多。与第三组无差异。
本研究表明，基线AMH水平低的女性对COH的反应与FSH水平升高所显示的卵巢储备功能下降的反应不良患者相似。因此，当接受IVF周期的女性AMH水平低时，无论FSH水平如何，都可被视为反应不良患者，尽管临床妊娠率并非如此令人失望（18%），但应告知这对夫妇取消周期的风险更高。
