Reijnders Igna F, Nelen Willianne L D M, IntHout Joanna, van Herwaarden Antonius E, Braat Didi D M, Fleischer Kathrin
Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2016 May;200:45-50. doi: 10.1016/j.ejogrb.2016.02.007. Epub 2016 Feb 27.
To determine the relation of Anti-Müllerian hormone (AMH) with live birth after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in women with (extremely) low ovarian reserve.
This study was a retrospective cohort study in a Dutch tertiary fertility clinic. Between January 2009 and March 2012, AMH levels were measured in infertile women when ≥36 years of age or when showing clinical signs of diminished ovarian reserve, before they underwent IVF or ICSI treatment. Ultimately, 156 women with (extremely) low ovarian reserve were included and evaluated for cumulative live birth rates. Of each woman, only one treatment cycle was analyzed, either the one in which she became pregnant or her first treatment cycle if she did not reach pregnancy. The relation between AMH and live birth was evaluated with multivariable logistic regression analysis. A ROC curve was composed to evaluate the discriminative value of AMH in relation to live birth after IVF/ICSI.
Thirty-three out of 156 women (21.2%) gave live birth. Live birth was significantly lower in women with AMH ≤0.1ng/ml (4/37 women; 10.8%) or AMH >0.1-0.4ng/ml (7/42 women; 16.7%), compared to women with AMH >0.4-1.05ng/ml (22/77 women; 28.6%), p<0.001. Multivariable logistic regression revealed an association between the severity of low ovarian reserve and live birth (per 0.1ng/ml increase in AMH value, Odds ratio 1.21; 95% CI 1.07-1.36).
The level of AMH is related to live birth after IVF/ICSI in women with (extremely) low ovarian reserve. The live birth rate in women with AMH >0.4ng/ml was significantly higher than in women with AMH ≤0.4ng/ml. AMH could serve as a tool in the pre-treatment counseling for pregnancy and live birth chances in women with (extremely) low ovarian reserve.
确定抗苗勒管激素（AMH）与（极）低卵巢储备女性体外受精（IVF）和卵胞浆内单精子注射（ICSI）后活产之间的关系。
本研究是在一家荷兰三级生育诊所进行的回顾性队列研究。2009年1月至2012年3月期间，对年龄≥36岁或有卵巢储备功能减退临床体征的不孕女性在接受IVF或ICSI治疗前测量AMH水平。最终，纳入156例（极）低卵巢储备女性并评估其累积活产率。对每位女性仅分析一个治疗周期，即其怀孕的周期或未怀孕时的第一个治疗周期。采用多变量逻辑回归分析评估AMH与活产之间的关系。绘制ROC曲线以评估AMH对IVF/ICSI后活产的判别价值。
156例女性中有33例（21.2%）活产。与AMH>0.4 - 1.05 ng/ml的女性（22/77例；28.6%）相比，AMH≤0.1 ng/ml的女性（4/37例；10.8%）或AMH>0.1 - 0.4 ng/ml的女性（7/42例；16.7%）活产率显著降低，p<0.001。多变量逻辑回归显示低卵巢储备严重程度与活产之间存在关联（AMH值每增加0.1 ng/ml，优势比为1.21；95%可信区间为1.07 - 1.36）。
AMH水平与（极）低卵巢储备女性IVF/ICSI后的活产有关。AMH>0.4 ng/ml的女性活产率显著高于AMH≤0.4 ng/ml的女性。AMH可作为（极）低卵巢储备女性妊娠和活产机会的治疗前咨询工具。
