Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Arch Gynecol Obstet. 2019 May;299(5):1495-1500. doi: 10.1007/s00404-019-05098-9. Epub 2019 Feb 21.
To investigate a possible influence of repetitive micro-traumata on the ovaries in the course of oocyte retrieval during IVF/ICSI treatment on serum anti-Müllerian hormone (AMH) levels.
The study included retrospectively collected data from women who underwent three or more consecutive IVF/ICSI treatments between 2007 and 2017. The primary endpoint of the study was to evaluate changes in serum AMH levels on cycle days 1-3 during the course of repetitive IVF/ICSI treatments.
A total of 125 patients were included in this study. Median AMH levels before the first, second and third IVF/ICSI cycles were 3.8 ng/mL (IQR 1.8-7.1), 3.3 ng/mL (IQR 1.8-6.1) and 3.0 ng/mL (IQR 1.6-5.3), respectively (p = n.s.). In patients who underwent IVF/ICSI due to polycystic ovary syndrome (PCOS), we found a significant decrease in AMH serum levels between the first [AMH 9.7 ng/mL (IQR 7.4-14.4)] and the third [AMH 5.3 ng/mL (IQR 3.3-10.4)] IVF/ICSI cycles (p = 0.026). When performing a generalized linear model, we found PCOS to be an independent predictor for serum AMH decrease during the course of three oocyte retrievals (p < 0.001).
When comparing the indications for IVF/ICSI, we observed a significant decrease in AMH serum levels after repetitive oocyte retrievals only in women with PCOS, while the decrease in AMH was not significant in patients with tubal factor, endometriosis, male factor and unexplained infertility. This finding leads us to hypothesize that repetitive micro-traumata on the ovarian cortex might diminish/normalize functional ovarian reserve in women with PCOS. Further prospective studies are highly warranted to allow firm conclusions.
研究在体外受精/卵胞浆内单精子注射（IVF/ICSI）治疗过程中取卵时反复微创伤是否对卵巢中血清抗苗勒管激素（AMH）水平有影响。
本研究回顾性收集了 2007 年至 2017 年期间连续进行三次或以上 IVF/ICSI 治疗的女性数据。该研究的主要终点是评估反复 IVF/ICSI 治疗过程中周期第 1-3 天血清 AMH 水平的变化。
本研究共纳入 125 例患者。第一次、第二次和第三次 IVF/ICSI 周期前 AMH 中位数水平分别为 3.8ng/ml（IQR 1.8-7.1）、3.3ng/ml（IQR 1.8-6.1）和 3.0ng/ml（IQR 1.6-5.3）（p=n.s.）。对于因多囊卵巢综合征（PCOS）而接受 IVF/ICSI 的患者，我们发现 AMH 血清水平在第一次[AMH 9.7ng/ml（IQR 7.4-14.4）]和第三次[AMH 5.3ng/ml（IQR 3.3-10.4）]IVF/ICSI 周期之间有显著下降（p=0.026）。当进行广义线性模型分析时，我们发现 PCOS 是三次取卵过程中 AMH 下降的独立预测因素（p<0.001）。
当比较 IVF/ICSI 的适应证时，我们仅在 PCOS 患者中观察到反复取卵后 AMH 血清水平显著下降，而在输卵管因素、子宫内膜异位症、男性因素和不明原因不孕患者中 AMH 下降不显著。这一发现使我们假设，卵巢皮质的反复微创伤可能会减少/正常化 PCOS 患者的功能性卵巢储备。需要进一步进行前瞻性研究以得出明确的结论。
