Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jingliu Road 157, Jinan, 250001, China.
National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China.
Reprod Biol Endocrinol. 2019 Jul 16;17(1):58. doi: 10.1186/s12958-019-0498-3.
To determine the effects of age and the serum anti-Müllerian hormone (AMH) level on in vitro fertilization (IVF) outcomes, especially among young women with low serum AMH levels and older women with high AMH levels.
This study was a cohort study in which a total of 9431 women aged 20-51 years who were undergoing their first IVF cycles were recruited. Ovarian response parameters included the number of retrieved oocytes, the number of 2 pronuclear zygotes (2PN), and the frequency of good-quality embryos (GQE). Pregnancy outcomes included the clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage rate (MR), and cumulative CPR and LBR (CCPR and CLBR).
Among women under 35 years of age, the ovarian response, CPR, CCPR, LBR and CLBR (p < 0.01) were significantly lower in the low-AMH group than in the average-AMH and high-AMH groups. In women above 35 years of age, the ovarian response, CPR, CCPR and CLBR (p < 0.01) were significantly higher in the average-AMH and low-AMH groups. The LBR in the older high-AMH group was significantly higher (37.45% vs 20.34%, p < 0.01) than that in the older low-AMH group, but there was no difference (37.45% vs 32.46%, p = 0.11) compared with the older average-AMH group. When there was a discrepancy between age and the AMH level, the young low-AMH group showed a poorer ovarian response but a better CPR (58.01% vs 49.44%, p < 0.01) and LBR (48.52% vs 37.45%, p < 0.01) than the older high-AMH group. However, the CCPR (65.37% vs 66.11%, p = 0.75) and CLBR (56.35% vs 52.89%, p = 0.15) between the two groups were comparable. The conservative CLBR in the two discrepancy groups increased until the third embryo transfer and reached a plateau thereafter.
CONCLUSION(S): Even with a relatively low AMH level, young women still had better pregnancy outcomes following IVF than older women. However, increasing the AMH level improves the cumulative outcomes of the older group to a comparable level through a notable and superior ovarian response.
为了确定年龄和血清抗苗勒管激素（AMH）水平对体外受精（IVF）结局的影响，特别是在血清 AMH 水平较低的年轻女性和血清 AMH 水平较高的老年女性中。
本研究为队列研究，共纳入 9431 名年龄在 20-51 岁、行首次 IVF 周期的女性。卵巢反应参数包括获卵数、2 原核受精卵（2PN）数和优质胚胎（GQE）频率。妊娠结局包括临床妊娠率（CPR）、活产率（LBR）、流产率（MR）和累积 CPR 和 LBR（CCPR 和 CLBR）。
在 35 岁以下的女性中，低 AMH 组的卵巢反应、CPR、CCPR、LBR 和 CLBR（p<0.01）明显低于平均 AMH 和高 AMH 组。在 35 岁以上的女性中，平均 AMH 和低 AMH 组的卵巢反应、CPR、CCPR 和 CLBR（p<0.01）明显较高。高龄高 AMH 组的 LBR 明显高于高龄低 AMH 组（37.45%比 20.34%，p<0.01），但与高龄平均 AMH 组无差异（37.45%比 32.46%，p=0.11）。当年龄和 AMH 水平存在差异时，年轻低 AMH 组的卵巢反应较差，但 CPR（58.01%比 49.44%，p<0.01）和 LBR（48.52%比 37.45%，p<0.01）较好。然而，两组间的 CCPR（65.37%比 66.11%，p=0.75）和 CLBR（56.35%比 52.89%，p=0.15）相当。两组的保守 CLBR 均随着第 3 次胚胎移植而增加，直至达到平台期。
即使 AMH 水平相对较低，年轻女性行 IVF 后的妊娠结局仍优于老年女性。然而，通过显著改善卵巢反应，增加 AMH 水平可使高龄组的累积结局提高到相当水平。
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