Gleicher Norbert, Kushnir Vitaly A, Sen Aritro, Darmon Sarah K, Weghofer Andrea, Wu Yan-Guang, Wang Qi, Zhang Lin, Albertini David F, Barad David H
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
The Foundation for Reproductive Medicine, New York, NY, USA.
J Transl Med. 2016 Jun 10;14(1):172. doi: 10.1186/s12967-016-0924-7.
Though outcome models have been proposed previously, it is unknown whether cutoffs in clinical pregnancy and live birth rates at all ages are able to classify in vitro fertilization (IVF) patients into good-, intermediate- and poor prognosis.
We here in 3 infertile patient cohorts, involving 1247, 1514 and 632 women, built logistic regression models based on 3 functional ovarian reserve (FOR) parameters, including (1) number of good quality embryos, (2) follicle stimulating hormone (FSH, mIU/mL) and (3) anti-Müllerian hormone (AMH, ng/mL), determining whether clinical pregnancy and live birth rates can discriminate between good, intermediate and poor prognosis patients.
All models, indeed, allowed at all ages for separation by prognosis, though cut offs changed with age. In the embryo model, increasing embryo production resulted in linear improvement of IVF outcomes despite transfer of similar embryo numbers; in the FSH model outcomes and FSH levels related inversely, while the association of AMH followed a bell-shaped polynomial pattern, demonstrating "best" outcomes at mid-ranges. All 3 models demonstrated increasingly poor outcomes with advancing ages, though "best" AMH even above age 43 was still associated with unexpectedly good pregnancy and delivery outcomes. Excessively high AMH, in contrast, was at all ages associated with spiking miscarriage rates.
At varying peripheral serum concentrations, AMH, thus, demonstrates hithero unknown and contradictory effects on IVF outcomes, deserving at different concentrations investigation as a potential therapeutic agent, with pregnancy-supporting and pregnancy-interrupting properties.
尽管此前已提出结局模型，但尚不清楚各年龄段临床妊娠率和活产率的临界值能否将体外受精（IVF）患者分为预后良好、中等和不良三类。
我们在3个不孕患者队列中（分别涉及1247名、1514名和632名女性），基于3个功能性卵巢储备（FOR）参数建立了逻辑回归模型，这3个参数包括：（1）优质胚胎数量；（2）促卵泡激素（FSH，mIU/mL）；（3）抗苗勒管激素（AMH，ng/mL），以确定临床妊娠率和活产率能否区分预后良好、中等和不良的患者。
事实上，所有模型在各年龄段都能按预后进行分类，不过临界值随年龄变化。在胚胎模型中，尽管移植的胚胎数量相似，但胚胎产量增加导致IVF结局呈线性改善；在FSH模型中，结局与FSH水平呈负相关，而AMH的关联呈钟形多项式模式，在中等水平时显示出“最佳 ”结局。所有3个模型均显示，随着年龄增长，结局越来越差，不过即使在43岁以上，“最佳”的AMH水平仍与意外良好的妊娠和分娩结局相关。相比之下，过高的AMH在各年龄段均与流产率飙升相关。
因此，在不同的外周血清浓度下，AMH对IVF结局显示出此前未知的矛盾影响，作为一种具有支持妊娠和终止妊娠特性的潜在治疗药物，在不同浓度下都值得研究。
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