血清抗苗勒管激素（AMH）用于 IVM 治疗的最佳阈值是多少？
What is the optimal threshold of serum Anti-Müllerian hormone (AMH) necessary for IVM treatments?
机构信息
IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
J Assist Reprod Genet. 2013 Jun;30(6):745-51. doi: 10.1007/s10815-013-9996-y. Epub 2013 Apr 23.
PURPOSE
To assesse circulating levels of Anti-Müllerian hormone (AMH) as a predictor of oocyte number and their potential to mature in vitro in both normo-ovulatory (NO) women and in women with Polycystic Ovary Syndrome (PCOS) undergoing in vitro maturation (IVM) treatments.
METHODS
We prospectively studied NO women and women diagnosed with PCOS, (age range 21-39 years) underwent IVM treatments at our center. Serum AMH levels were quantified before each cycle and correlated to oocytes number, maturation and fertilization during in vitro maturation.
RESULTS
104 NO and 30 PCOS IVM cycles were followed with retrieval of a total of 672 and 491 oocytes, respectively. In NO women, the serum AMH level positively correlated with the number of oocytes retrieved, (R = 0.6; P <0.0001) the number of M2 oocytes at 24 and 48 h (R = 0.4; P <0.01; R = 0.26 p < 0.007, respectively) and with the total number of M2 oocytes (R = 0.47; P < 0.0001). In the PCOS group, the serum AMH level positively correlated only with the number of oocytes retrieved (R = 0.43; P <0.03). Receiver operating characteristic (ROC) analyses showed that a cutoff AMH level of 1.56 (ng/ml) could identify patients with 5 or more oocytes at OPU with a sensitivity of 83 % and a specificity of 75 %. An AMH level of 1.63 (ng/ml) was the threshold for 5 or more matured oocytes (sensitivity = 81 %, specificity = 53 %).
CONCLUSIONS
Serum AMH may be used as a marker to identify candidates for IVM treatment in both NO and PCOS women.
目的
评估抗缪勒管激素（AMH）的循环水平，作为预测卵母细胞数量及其在体外成熟潜能的指标，该研究对象为接受体外成熟（IVM）治疗的正常排卵（NO）妇女和多囊卵巢综合征（PCOS）妇女。
方法
我们前瞻性地研究了在我们中心接受 IVM 治疗的 NO 妇女和诊断为 PCOS 的妇女（年龄 21-39 岁）。在每个周期前定量检测血清 AMH 水平，并将其与体外成熟过程中的卵母细胞数量、成熟和受精相关联。
结果
共随访了 104 个 NO 和 30 个 PCOS 的 IVM 周期，分别获得了 672 个和 491 个卵母细胞。在 NO 妇女中，血清 AMH 水平与获得的卵母细胞数量呈正相关（R=0.6；P<0.0001），与 24 小时和 48 小时的 M2 卵母细胞数量呈正相关（R=0.4；P<0.01；R=0.26，P<0.007），与总 M2 卵母细胞数量呈正相关（R=0.47；P<0.0001）。在 PCOS 组中，血清 AMH 水平仅与获得的卵母细胞数量呈正相关（R=0.43；P<0.03）。受试者工作特征（ROC）分析显示，血清 AMH 水平为 1.56（ng/ml）时，可识别出在 OPU 获得 5 个或更多卵母细胞的患者，其灵敏度为 83%，特异性为 75%。血清 AMH 水平为 1.63（ng/ml）时，为获得 5 个或更多成熟卵母细胞的阈值（灵敏度=81%，特异性=53%）。
结论
血清 AMH 可作为预测 NO 和 PCOS 妇女 IVM 治疗候选者的标志物。
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