Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, 361002, China.
Clinical Laboratory, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, 361002, China.
J Assist Reprod Genet. 2018 Mar;35(3):467-473. doi: 10.1007/s10815-017-1095-z. Epub 2017 Dec 21.
The purpose of this study is to investigate whether individual response of anti-Mullerian hormone (AMH) to gonadotropin-releasing hormone (GnRH) treatment is associated with difference in ovarian stimulation outcomes.
The retrospective study included 1058 non-polycystic ovary syndrome (PCOS) women undergoing long agonist protocol in a single in vitro fertilization unit from January 1, 2016, through December 31, 2016. Patients were grouped according to AMH changes from day 3 to the day of stimulation (group 1, change < 1 ng/ml, n = 714; group 2, decrease ≥ 1 ng/ml, n = 143; group 3, increase ≥ 1 ng/ml, n = 201). A generalized linear model including Poisson distribution and log link function was used to evaluate the association between AMH response and the number of oocytes retrieved.
Group 2 was characterized by higher basal AMH level and increased AMH to AFC ratio in comparison with two other groups. However, the number of oocytes and ovarian sensitivity index in group 2 was significantly lower than group 3. Adjusted for age, BMI, ovarian reserve markers, and stimulation parameters, the population marginal means (95% confidence interval) of oocyte number in groups 1 through 3 were 9.51 (9.17, 9.86), 8.04 (7.54, 8.58), and 10.65 (10.15, 11.18), respectively. For patients from group 2 and group 3, basal AMH is no longer significantly associated with oocyte yield.
AMH change in response to GnRH agonist varies among individuals; for those undergoing significant changes in AMH following GnRH agonist treatment, basal AMH may not be a reliable marker for ovarian response in long agonist protocol.
本研究旨在探讨抗苗勒管激素（AMH）对促性腺激素释放激素（GnRH）治疗的个体反应是否与卵巢刺激结局的差异有关。
本回顾性研究纳入了 2016 年 1 月 1 日至 12 月 31 日期间在单一体外受精中心接受长激动剂方案的 1058 例非多囊卵巢综合征（PCOS）患者。根据 AMH 从第 3 天到刺激日的变化将患者分为 3 组（第 1 组，变化 < 1ng/ml，n=714；第 2 组，下降≥1ng/ml，n=143；第 3 组，增加≥1ng/ml，n=201）。采用包括泊松分布和对数链接函数的广义线性模型评估 AMH 反应与获卵数之间的关系。
与另外两组相比，第 2 组的基础 AMH 水平更高，AMH 与 AFC 比值增加。然而，第 2 组的获卵数和卵巢敏感性指数明显低于第 3 组。调整年龄、BMI、卵巢储备标志物和刺激参数后，第 1 至 3 组的卵母细胞数量的总体边际均值（95%置信区间）分别为 9.51（9.17，9.86）、8.04（7.54，8.58）和 10.65（10.15，11.18）。对于第 2 组和第 3 组的患者，基础 AMH 与卵母细胞产量不再显著相关。
AMH 对 GnRH 激动剂的反应因人而异；对于 GnRH 激动剂治疗后 AMH 发生显著变化的患者，基础 AMH 可能不是长激动剂方案中卵巢反应的可靠标志物。
