Zebitay Ali G, Cetin Orkun, Verit Fatma F, Keskin Seda, Sakar M Nafi, Karahuseyinoglu Sercin, Ilhan Gulsah, Sahmay Sezai
a In vitro Fertilization Unit , Suleymaniye Maternity and Women's Disease Education and Research Hospital , Istanbul, Turkey.
b Department of Histology and Embryology , Koc University School of Medicine , Sariyer Istanbul , Turkey.
J Obstet Gynaecol. 2017 May;37(4):492-497. doi: 10.1080/01443615.2016.1269730. Epub 2017 Feb 17.
To evaluate the role of ovarian reserve markers in the prediction of clinical pregnancy and embryo transfer accomplishment among poor responder IVF applicants. 304 female poor responder IVF applicants were included in this prospective cohort study conducted at the IVF-unit. Antral follicle count, FSH, LH, E2, AMH and IVF outcomes were compared in pregnant and non-pregnant groups as well as in ET vs. non-ET groups. The number of retrieved oocytes was significantly correlated positively with AMH and AFC, and negatively with FSH and age. Quartiles of FSH and AFC were similar to the rate of pregnancy. Quartiles of AMH (<25%/25-75% and <25%/>75%) were statistically significant. Mean serum levels for AMH were significantly lower in the non-ET group. Our findings seem to indicate that day 3 AMH values can predict ET accomplishment with a sensitivity of 96% and a specificity of 35%. Quartiles of AMH <25% (< 0.21 ng/mL) can predict the IVF results among poor responder IVF applicants. Impact statement Various cut-off values have been determined for day 3 serum AMH values. These values help to determine the groups that are expected to give normal, high or low response to stimulation and decide the treatment options. In contrast to other groups of patients, poor responders cannot reach the embryo transfer stage for several reasons. These are; absence of a mature oocyte after oocyte pick-up, fertilisation failure without male factor or poor embryo quality. In the present study; a cut-off value of 0.33 ng/mL for the prediction of ET accomplishment in poor responder patients was determined with a sensitivity of 96%. Additionally, clinical pregnancy could not be achieved under the value of 0.21 ng/mL day 3 AMH values. It is important to clarify the embryo transfer success of poor responder patients prior to expected treatment success. Pre-treatment counselling for these patients would lessen the disappointment that may develop after treatment. The cost-effectiveness of treatments below these AMH values can be determined by further studies.
评估卵巢储备标志物在预测低反应性体外受精（IVF）申请者临床妊娠及胚胎移植成功中的作用。本前瞻性队列研究在IVF单元开展，纳入了304名低反应性IVF女性申请者。比较了妊娠组和非妊娠组以及胚胎移植（ET）组和非ET组的窦卵泡计数、促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇（E2）、抗苗勒管激素（AMH）及IVF结局。获卵数与AMH和AFC呈显著正相关，与FSH和年龄呈负相关。FSH和AFC的四分位数与妊娠率相似。AMH的四分位数（<25%/25 - 75%和<25%/>75%）具有统计学意义。非ET组的AMH平均血清水平显著更低。我们的研究结果似乎表明，第3天的AMH值可预测ET成功，敏感性为96%，特异性为35%。AMH<25%（<0.21 ng/mL）的四分位数可预测低反应性IVF申请者的IVF结果。影响声明 已确定第3天血清AMH值的各种临界值。这些值有助于确定预期对刺激有正常、高或低反应的组，并决定治疗方案。与其他患者组不同，低反应者由于多种原因无法达到胚胎移植阶段。这些原因包括：取卵后未获得成熟卵子、无男性因素的受精失败或胚胎质量差。在本研究中；确定了预测低反应者患者ET成功的临界值为0.33 ng/mL，敏感性为96%。此外，第3天AMH值低于0.21 ng/mL时无法实现临床妊娠。在预期治疗成功之前明确低反应者患者的胚胎移植成功率很重要。对这些患者进行治疗前咨询可减少治疗后可能产生的失望情绪。低于这些AMH值的治疗的成本效益可通过进一步研究确定。
