Department of Obstetrics and Gynecology, Mizonokuchi Hospital, Teikyo University, Kawasaki, 213-8507, Japan.
J Assist Reprod Genet. 2013 Jun;30(6):821-5. doi: 10.1007/s10815-013-9991-3. Epub 2013 May 3.
Although studies of serum anti-Müllerian hormone (AMH) in predicting ovarian reserve are numerous, many studies utilized patients under age 40. However, the assessment of ovarian reserve is especially critical in older infertile women. This study evaluates the significance of AMH level in patients over age 40 at the time of their first in vitro fertilization (IVF) treatment.
Forty-nine women over age 40 were studied. Although serum samples were taken prior to their IVF treatments, the data of serum AMH of patients were not taken into consideration to determine the therapy strategy, including follicle induction in which clomiphene citrate and human menopausal gonadotropin were used.
RESULT(S): Twelve out of 49 patients achieved a clinical pregnancy (24.4 %). There was a positive correlation between serum AMH levels and the number of oocytes retrieved (P < 0.0001). The ROC curve analysis for prediction of poor ovarian response, ≤3 retrieved oocytes, showed that the optimum cut-off level was < 1.0 ng/mL for AMH. The lower AMH group (AMH < 1.0 ng/ml) showed less chance of undergoing embryo transfer than the higher AMH group (AMH ≥1.0 ng/ml). There was no difference in pregnancy rate between the two groups. Five out of 12 pregnant women exhibited AMH levels of less than 0.4 ng/ml.
CONCLUSION(S): Assessment of serum AMH concentration in older patients is useful for the prediction of oocytes numbers which may be obtained in IVF. A cut-off level of 1.0 ng/ml AMH can be used to predict poor ovarian response. This cut-off level of AMH of 1.0 ng/ml might be useful to predict whether patients could have an embryo transfer, but had no power to predict achieving pregnancy. On the other hand, our data also showed that patients over age 40 with extreme low levels of AMH still had a chance of pregnancy.
尽管有许多关于血清抗苗勒管激素（AMH）预测卵巢储备的研究，但许多研究都使用了年龄在 40 岁以下的患者。然而，在年龄较大的不孕女性中，卵巢储备的评估尤其重要。本研究评估了在首次体外受精（IVF）治疗时年龄超过 40 岁的患者中 AMH 水平的意义。
研究了 49 名年龄超过 40 岁的女性。尽管在进行 IVF 治疗前采集了血清样本，但并未考虑患者的血清 AMH 数据来确定治疗策略，包括使用枸橼酸氯米酚和人绝经期促性腺激素进行卵泡诱导。
49 名患者中有 12 名获得临床妊娠（24.4%）。血清 AMH 水平与获得的卵母细胞数量呈正相关（P<0.0001）。预测卵巢反应不良（≤3 个卵母细胞）的 ROC 曲线分析显示，AMH 的最佳截断值为<1.0ng/ml。AMH 较低组（AMH<1.0ng/ml）进行胚胎移植的机会小于 AMH 较高组（AMH≥1.0ng/ml）。两组的妊娠率无差异。12 名妊娠妇女中有 5 名 AMH 水平低于 0.4ng/ml。
对年龄较大的患者进行血清 AMH 浓度评估有助于预测 IVF 中可能获得的卵母细胞数量。AMH 截断值为 1.0ng/ml 可用于预测卵巢反应不良。AMH 截断值为 1.0ng/ml 可能有助于预测患者是否可以进行胚胎移植，但对预测妊娠无影响。另一方面，我们的数据还表明，AMH 水平极低的年龄超过 40 岁的患者仍有妊娠机会。
