Chen Ya, Ye Bilv, Yang Xiaojing, Zheng Jiujia, Lin Jinju, Zhao Junzhao
1 Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
2 Gynaecology and Obstetrics Department, The First People's Hospital of Hangzhou, Hangzhou, Zhejiang, China.
J Int Med Res. 2017 Jun;45(3):1138-1147. doi: 10.1177/0300060517704140. Epub 2017 Apr 28.
Objective This study evaluated associations of basal serum and follicular fluid (FF) anti-Muüllerian hormone (AMH) levels with in vitro fertilization (IVF) outcomes in polycystic ovary syndrome (PCOS) patients. Methods This prospective study included 179 consecutive women undergoing IVF, including 59 with PCOS and non-PCOS controls. Thirty PCOS cases had long gona-dotrophin-releasing hormone agonist (GnRH-a) and 29 had antagonist (GnRH-ant) protocols. Controls underwent conventional GnRH-a. Associations of basal serum and FF AMH levels with IVF outcomes were assessed. Results Median serum and FF AMH levels, antral follicle count (AFC), oestradiol human chorionic gonadotropin injection day (peak E2), and retrieved oocyte numbers were higher in PCOS patients than in controls (all P < 0.01). Oocyte maturation and high-quality embryo rates were lower in PCOS patients than in controls (P < 0.01), but both groups had similar fertilization, implantation, clinical pregnancy, and newborn rates. Peak E2 was higher in GnRH-ant than in GnRH-a protocols (16.5 nmol/L vs. 12.1 nmol/L, P < 0.05). AMH levels were correlated with AFC in PCOS patients ( P < 0.01). Peak E2 and FF AMH levels were independent predictors of oocyte number. Peak E2 predicted the fertilization rate. Conclusion Serum basal AMH levels are predictive of oocyte quantity, but not oocyte quality or IVF outcomes. Serum AMH, FF AMH, and outcomes are similar among protocols.
目的 本研究评估多囊卵巢综合征（PCOS）患者基础血清和卵泡液（FF）抗苗勒管激素（AMH）水平与体外受精（IVF）结局之间的关联。方法 这项前瞻性研究纳入了179例连续接受IVF的女性，包括59例PCOS患者和非PCOS对照。30例PCOS患者采用长效促性腺激素释放激素激动剂（GnRH-a）方案，29例采用拮抗剂（GnRH-ant）方案。对照采用传统的GnRH-a方案。评估基础血清和FF AMH水平与IVF结局之间的关联。结果 PCOS患者的血清和FF AMH水平中位数、窦卵泡计数（AFC）、人绒毛膜促性腺激素注射日雌二醇（E2峰值）和回收的卵母细胞数量均高于对照组（均P<0.01）。PCOS患者的卵母细胞成熟率和优质胚胎率低于对照组（P<0.01），但两组的受精、着床、临床妊娠和新生儿率相似。GnRH-ant方案的E2峰值高于GnRH-a方案（16.5 nmol/L对12.1 nmol/L，P<0.05）。PCOS患者的AMH水平与AFC相关（P<0.01）。E2峰值和FF AMH水平是卵母细胞数量的独立预测指标。E2峰值可预测受精率。结论 血清基础AMH水平可预测卵母细胞数量，但不能预测卵母细胞质量或IVF结局。不同方案之间血清AMH、FF AMH和结局相似。
