Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California.
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
Fertil Steril. 2018 Aug;110(3):506-513.e3. doi: 10.1016/j.fertnstert.2018.03.031. Epub 2018 Jun 28.
To evaluate a new fully automated antimüllerian hormone (AMH) assay for prediction of poor ovarian response (POR) to ovarian stimulation defined as four or fewer oocytes retrieved.
Prospective cohort study.
Thirteen private and academic fertility centers in the United States.
PATIENTS(S): A total of 178 women undergoing their first in vitro fertilization (IVF) cycle eligible for the study were consented and enrolled, with data available from 160 women for prediction of POR and 164 women for AMH correlation with antral follicle count (AFC).
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Cutoff point for AMH that predicts POR. Correlation of AMH with AFC, and cutoff point for AMH that correlates with antral follicle count >15.
RESULT(S): The mean AMH among the poor responders was 0.74 ng/mL, compared with 3.20 ng/mL for normal to high responders. The AMH cutoff at 90% specificity for predicting POR with the use of the receiver operating characteristic (ROC) curve was 0.93 ng/mL, with an associated sensitivity of 74.1%. For prediction of POR, ROC analysis showed that AMH (area under the ROC curve [AUC] = 0.929) was significantly better than FSH (AUC = 0.615; P<.0001). AMH was positively correlated with AFC (Spearman rho = 0.756). The AMH at 90% sensitivity for AFC >15 was 1.75, with specificity of 59.1%.
CONCLUSION(S): A fully automated AMH assay can be a useful biomarker for predicting POR in IVF cycles. Because AMH cutoff points vary depending on the assay used, future studies should continue to calibrate test results to clinically important outcomes.
评估一种新的全自动抗苗勒管激素（AMH）检测方法，以预测卵巢刺激反应不良（POR），其定义为取卵数<4 枚。
前瞻性队列研究。
美国 13 家私立和学术性生育中心。
共纳入 178 名符合研究条件的首次体外受精（IVF）周期患者，其中 160 名患者的数据可用于预测 POR，164 名患者的数据可用于 AMH 与窦卵泡计数（AFC）的相关性分析。
无。
预测 POR 的 AMH 截断值。AMH 与 AFC 的相关性，以及与 AFC>15 相关的 AMH 截断值。
POR 组患者的 AMH 均值为 0.74ng/ml，而正常至高反应组患者的 AMH 均值为 3.20ng/ml。采用受试者工作特征（ROC）曲线分析，预测 POR 时 90%特异性的 AMH 截断值为 0.93ng/ml，其灵敏度为 74.1%。对于 POR 的预测，ROC 分析显示 AMH（ROC 曲线下面积[AUC]为 0.929）明显优于 FSH（AUC=0.615；P<.0001）。AMH 与 AFC 呈正相关（Spearman rho=0.756）。预测 AFC>15 时的 AMH 截断值为 1.75，其特异性为 59.1%。
全自动 AMH 检测方法可作为预测 IVF 周期 POR 的有用生物标志物。由于 AMH 截断值因检测方法不同而存在差异，因此未来的研究应继续将检测结果校准至具有临床意义的结局。
