血清抗苗勒管激素水平预测接受辅助生殖技术控制性卵巢刺激的多囊卵巢综合征和非多囊卵巢综合征女性的高反应。
Serum AMH Level to Predict the Hyper Response in Women with PCOS and Non-PCOS Undergoing Controlled Ovarian Stimulation in ART.
作者信息
Vembu Radha, Reddy Nellepalli Sanjeeva
机构信息
Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, Tamilnadu, India.
出版信息
J Hum Reprod Sci. 2017 Apr-Jun;10(2):91-94. doi: 10.4103/jhrs.JHRS_15_16.
BACKGROUND
It is essential to determine the cut-off value of serum anti-Mullerian hormone (AMH) to predict the hyper response in assisted reproductive technology (ART). There are few studies mentioning the cut-off value for the hyper response in infertile women but not specifically for polycystic ovary syndrome (PCOS) and non-PCOS groups. With this in background, this study was conducted.
AIM
To determine the cut-off value of serum AMH to predict the hyper response in women with PCOS and non-PCOS undergoing a controlled ovarian stimulation (COS) in ART.
OBJECTIVE
To compare the outcome of stimulation in PCOS and non-PCOS groups.
MATERIALS AND METHODS
All 246 women enrolled for Intra Cytoplasmic Sperm Injection (ICSI) fulfilling the selection criteria were recruited. On the day 3 of the cycle, the serum AMH, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol and antral follicle count (AFC) were measured. They underwent COS as per the unit protocol. They were divided into PCOS and non-PCOS groups as per the Rotterdam's criteria. The mean age, duration of infertility, Body Mass Index (BMI), Ovarian reserve markers and outcome of stimulation were compared. Using the Statistical Package for the Social Sciences version 16.0 software, the significant difference was measured by multivariate analysis, as well as a one-way analysis of variance with Tukey's post-hoc test was used.
RESULTS
Among 246 women, 31.3% were in PCOS group, and 68.7% were in non-PCOS group. Comparison of PCOS and non-PCOS groups showed a significant difference in the age with the mean age being 29.2 and 31.5 years, respectively. The mean AMH and AFC were 2-fold higher in PCOS group. The mean number of follicles, oocytes retrieved, MII and oocytes fertilised were significantly higher in PCOS group. The pregnancy rate was 52.6% in PCOS and 30.9% in non-PCOS group. In the PCOS group, 22.1% had ovarian hyper stimulation syndrome (OHSS), and only 4.7% had OHSS in non-PCOS group ( = 0.0005). Receiving Operator Curve (ROC) curve was plotted to predict the hyper response, which showed a cut-off value of 6.85 ng/ml with a sensitivity of 66.7% and a specificity of 68.7% for PCOS group and 4.85 ng/ml with a sensitivity of 85.7% and a specificity of 89.7% in non-PCOS group.
CONCLUSION
The cut-off value of serum AMH to predict the hyper response in PCOS group is 6.85 ng/ml and in non-PCOS group is 4.85 ng/ml.
背景
确定血清抗苗勒管激素（AMH）的临界值对于预测辅助生殖技术（ART）中的高反应至关重要。很少有研究提及不育女性高反应的临界值，但未特别针对多囊卵巢综合征（PCOS）和非PCOS组。基于此背景，开展了本研究。
目的
确定血清AMH的临界值，以预测接受ART中控制性卵巢刺激（COS）的PCOS和非PCOS女性的高反应。
目标
比较PCOS组和非PCOS组的刺激结果。
材料与方法
招募了所有符合入选标准并接受卵胞浆内单精子注射（ICSI）的246名女性。在月经周期第3天，测量血清AMH、促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇和窦卵泡计数（AFC）。她们按照单位方案接受COS。根据鹿特丹标准将她们分为PCOS组和非PCOS组。比较两组的平均年龄、不孕持续时间、体重指数（BMI）、卵巢储备指标和刺激结果。使用社会科学统计软件包16.0软件，通过多变量分析测量显著差异，并使用单因素方差分析及Tukey事后检验。
结果
246名女性中，31.3%在PCOS组，68.7%在非PCOS组。PCOS组和非PCOS组比较显示，年龄存在显著差异，平均年龄分别为29.2岁和31.5岁。PCOS组的平均AMH和AFC高出2倍。PCOS组的平均卵泡数、获卵数、成熟卵母细胞数（MII）和受精卵母细胞数显著更高。PCOS组的妊娠率为52.6%，非PCOS组为30.9%。PCOS组中22.1%发生卵巢过度刺激综合征（OHSS），非PCOS组仅4.7%发生OHSS（P = 0.0005）。绘制受试者工作特征曲线（ROC曲线）以预测高反应，结果显示PCOS组的临界值为6.85 ng/ml，敏感性为66.7%，特异性为68.7%；非PCOS组的临界值为4.85 ng/ml，敏感性为85.7%，特异性为89.7%。
结论
预测PCOS组高反应的血清AMH临界值为6.85 ng/ml，非PCOS组为4.85 ng/ml。
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