循环抗苗勒管激素对多囊卵巢综合征女性卵巢对促性腺激素诱导排卵反应性的影响：一项初步研究。
The influence of circulating anti-Müllerian hormone on ovarian responsiveness to ovulation induction with gonadotrophins in women with polycystic ovarian syndrome: a pilot study.
作者信息
Amer Saad A, Mahran Ahmad, Abdelmaged Ayman, El-Adawy Ahmad R, Eissa Moustafa K, Shaw Robert W
机构信息
Department of Obstetrics and Gynaecology, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby DE22 3DT, UK.
出版信息
Reprod Biol Endocrinol. 2013 Dec 17;11:115. doi: 10.1186/1477-7827-11-115.
BACKGROUND
Women with polycystic ovarian syndrome (PCOS) are known to have elevated circulating Anti-Müllerian hormone (AMH), which has been found to desensitize ovarian follicles to follicle stimulating hormone (FSH). The purpose of this study was to investigate the impact of high circulating AMH on ovarian responsiveness to ovulation induction with gonadotrophins in PCOS women.
METHODS
This prospective observational pilot study was conducted in two collaborating Fertility Centres in the UK and Egypt. The study included 20 consecutive anovulatory women with PCOS who underwent 34 cycles of human menopausal gonadotrophin (hMG) ovarian stimulation using chronic low-dose step up protocol. Blood samples were collected for the measurement of serum AMH concentrations in the early follicular (day 2-3) phase in all cycles of hMG treatment. The serum levels of AMH were compared between cycles with good vs. poor response. The good response rates and the total dose and duration of hMG treatment were compared between cycles with high vs. low serum AMH concentrations.
RESULTS
Cycles with poor response (no or delayed ovulation requiring >20 days of hMG treatment) had significantly (p = .007) higher median{range} serum AMH concentration (6.5{3.2-13.4}ng/ml) compared to that (4.0{2.2-10.2}ng/ml) of cycles with good response (ovulation within 20 days of hMG treatment). ROC curve showed AMH to be a useful predictor of poor response to hMG stimulation (AUC, 0.772; P = 0.007). Using a cut-off level of 4.7 ng/ml, AMH had a sensitivity of 100% and specificity of 58% in predicting poor response. The good response rate was significantly (p < .001) greater in cycles with lower AMH (<4.7 ng/ml) compared to that in those with AMH > = 4.7 ng/ml (100% vs. 35%, respectively). All cycles with markedly raised serum AMH levels (> 10.2 ng/ml) were associated with poor response. Cycles with high AMH (> = 4.7 ng/ml) required significantly (p < .001) greater amounts (median {range}, 1087{450-1650}IU) and longer duration (20 {12-30}days) of hMG stimulation than cycles with lower AMH (525 {225-900}IU and 8{6-14}days).
CONCLUSIONS
PCOS women with markedly raised circulating AMH seem to be resistant to hMG ovulation induction and may require a higher starting dose.
背景
已知多囊卵巢综合征（PCOS）女性循环中的抗苗勒管激素（AMH）升高，已发现其会使卵巢卵泡对促卵泡激素（FSH）产生脱敏作用。本研究的目的是调查高循环AMH对PCOS女性卵巢对促性腺激素诱导排卵反应性的影响。
方法
这项前瞻性观察性试点研究在英国和埃及的两个合作生育中心进行。该研究纳入了20例连续的无排卵PCOS女性，她们使用慢性低剂量递增方案接受了34个周期的人绝经期促性腺激素（hMG）卵巢刺激。在hMG治疗的所有周期中，于卵泡早期（第2 - 3天）采集血样以测量血清AMH浓度。比较反应良好与反应不良周期之间的AMH血清水平。比较血清AMH浓度高与低的周期之间的良好反应率以及hMG治疗的总剂量和持续时间。
结果
与反应良好的周期（hMG治疗20天内排卵）相比，反应不良的周期（无排卵或排卵延迟，需要>20天的hMG治疗）的血清AMH中位数{范围}浓度显著更高（p = 0.007），分别为6.5{3.2 - 13.4}ng/ml和4.0{2.2 - 10.2}ng/ml。ROC曲线显示AMH是hMG刺激反应不良的有用预测指标（AUC，0.772；P = 0.007）。使用4.7 ng/ml的临界值，AMH预测反应不良的敏感性为100%，特异性为58%。与AMH≥4.7 ng/ml的周期相比，AMH较低（<4.7 ng/ml）的周期的良好反应率显著更高（p < 0.001）（分别为100%和35%）。所有血清AMH水平明显升高（>10.2 ng/ml）的周期均与反应不良相关。与AMH较低的周期相比，AMH高（≥4.7 ng/ml）的周期需要显著更多的hMG刺激量（中位数{范围}，1087{450 - 1650}IU）和更长的持续时间（20{12 - 30}天）（525{225 - 900}IU和8{6 - 14}天）。
结论
循环AMH明显升高的PCOS女性似乎对hMG诱导排卵有抗性，可能需要更高的起始剂量。
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