Chen Y H, Wang Q, Zhang Y N, Xu X H, Lu J, Zhang S D, Zhang C L
Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Zhonghua Fu Chan Ke Za Zhi. 2019 Apr 25;54(4):239-244. doi: 10.3760/cma.j.issn.0529-567x.2019.04.005.
To explore the value of anti-Müllerian hormone (AMH) and age in predicting outcomes of patients undergoing in vitro fertilization and embryo transfer treatment. In this retrospective study, 6 328 Chinese patients who underwent the first in vitro fertilization or intracytoplasmic sperm injection and embryo transfer treatment in Henan Provincial Peoples Hospital between July 2016 and July 2018 were analyzed. All the patients were categorized into two groups according to pregnancy or not. Baseline data and outcomes of two groups were compared. The regression analysis was conducted to identify the independent factors of clinical pregnancy rates. Furthermore, correlation analysis was performed between AMH and other factors. (1) The total clinical pregnancy rate was 56.86% (3 547/6 238). Age, AMH, basal FSH, antral follicle number (AFC), starting dose of gonadotropin (Gn), total doses of Gn, duration of Gn, number of oocytes, transferable cleavage embryos and transferred embryos were significantly different (all 0.01). (2) Correlation analysis showed that AMH had significant passive correlation with age, basal FSH, starting dose of Gn and total doses of Gn (all 0.01), while showed significant positive correlation with AFC, body mass index, duration of Gn, number of oocytes and transferable cleavage embryos (all 0.01). Of all the factors, AMH had the strongest correlation with AFC (0.01). (3) Multivariate logistic regression analysis suggested that age was the independent influencing factor of clinical pregnancy rate (0.938, 95: 0.824-0.952, 0.01), while AMH not (1.004, 95: 0.984-1.024, 0.687). In the subgroups according to age, the advanced group (age>35 years old) had lower clinical pregnancy rate and higher cancellation rate for no available embryos. AMH has no predictive value of clinical pregnancy outcomes for patients with in vitro fertilization and embryo transfer treatment, while age has certain predictive value of pregnancy outcomes. AMH level may have indictive value for the evaluation of ovarian reserve.
探讨抗苗勒管激素(AMH)和年龄对体外受精-胚胎移植治疗患者结局的预测价值。在这项回顾性研究中,分析了2016年7月至2018年7月期间在河南省人民医院首次接受体外受精或卵胞浆内单精子注射及胚胎移植治疗的6328例中国患者。所有患者根据是否妊娠分为两组。比较两组的基线数据和结局。进行回归分析以确定临床妊娠率的独立因素。此外,还对AMH与其他因素进行了相关性分析。(1)总临床妊娠率为56.86%(3547/6238)。年龄、AMH、基础促卵泡生成素(FSH)、窦卵泡数(AFC)、促性腺激素(Gn)起始剂量、Gn总剂量、Gn用药时间、卵母细胞数、可移植卵裂期胚胎数和移植胚胎数差异均有统计学意义(均P<0.01)。(2)相关性分析显示,AMH与年龄、基础FSH、Gn起始剂量和Gn总剂量呈显著负相关(均P<0.01),而与AFC、体重指数、Gn用药时间、卵母细胞数和可移植卵裂期胚胎数呈显著正相关(均P<0.01)。在所有因素中,AMH与AFC的相关性最强(P<0.01)。(3)多因素logistic回归分析提示,年龄是临床妊娠率的独立影响因素(OR=0.938,95%CI:0.824-0.952,P<0.01),而AMH不是(OR=1.004,95%CI:0.984-1.024,P=0.687)。在按年龄分组的亚组中,高龄组(年龄>35岁)临床妊娠率较低,无可用胚胎取消率较高。AMH对体外受精-胚胎移植治疗患者的临床妊娠结局无预测价值,而年龄对妊娠结局有一定的预测价值。AMH水平可能对评估卵巢储备有指示价值。