Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
Arch Gynecol Obstet. 2020 Apr;301(4):1089-1094. doi: 10.1007/s00404-020-05491-9. Epub 2020 Mar 16.
Serum anti-Mullerian hormone (AMH) shows a strong positive correlation to the number of oocytes retrieved but the patients undergoing assisted reproductive technology (ART) with lower AMH concentrations also could retrieve an ideal number of oocytes sometimes. The aim of the current study was to assess the performance of this population.
This retrospective study included a total of 44 in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles as test group, in which their AMH levels were below the limit of reference range but more than 7 eggs were retrieved, and 103 control cases enrolled from May 2016 to December 2018 after matched with the same range of age from 24 to 38 years old and the same number range of retrieved oocytes from 7 to 18 and chosen randomly according to clinical ovarian stimulation protocols by the ratio of 3:7. Several parameters, which include age, basal endocrine status, number of oocytes, the maturation rate of eggs, 2PN fertilization rate, 3PN rate, total fertilization rate, cleavage rate, 8-cell embryo rate of D3 and the utilization rate of embryo, were compared and evaluated between two groups by Wilcoxon rank-sum test and t test for two independent samples.
Although the same age range from 24 to 38 years and the same retrieval eggs from 7 to 18, compared with the control group, the test group showed less number of oocytes collected (9.455 vs 10.767, p = 0.016), younger ages (28.36 vs 32.59, p = 0.000), and higher FSH of basal endocrine status (9.783 vs 7.338, p = 0.021). Between the two groups, there were no significant differences in parameters such as the mature eggs (7.05 vs 7.92, p = 0.079), the mature oocyte rate (74.189% vs 73.916%, p = 0.924), the number of 2PNs (5.36 vs 5.91, p = 0.236), 2PN rate (73.678% vs 75.125%, p = 0.769), the number of 3PNs (0.39 vs 0.50, p = 0.773), 3PN rate (5.104% vs 5.592%, p = 0.697), number of total fertilizations (6.77 vs 7.35, p = 0.241), total fertilization rate (96.461% vs 93.166%, p = 0.332), cleavage rate (82.003% vs 81.382%, p = 0.673), the number of 8-cells on D3 (1.59 vs 1.91, p = 0.227), the rate of 8-cell on D3 (36.259% vs 41.084%, p = 0.551) and the utilization rate of embryo (62.853% vs 61.824%, p = 0.806).
These findings indicate that there are no significant differences in the maturation of oocytes and the embryo quality for the women with low AMH level and ideal retrieval eggs but they should undergo IVF treatment and achieve successful pregnancy as soon as possible due to the higher basal FSH, the relatively fewer number of retrieval eggs and the possibility of coming diminished ovarian reserve (DOR) or poor respond (PR) despite their younger ages.
血清抗苗勒管激素（AMH）与获得的卵母细胞数量呈强正相关，但接受辅助生殖技术（ART）的患者，即使 AMH 浓度较低，有时也能获得理想数量的卵母细胞。本研究的目的是评估这部分人群的表现。
本回顾性研究共纳入 44 例体外受精（IVF）/卵胞浆内单精子注射（ICSI）治疗周期作为实验组，其 AMH 水平低于参考范围下限，但获得的卵母细胞数超过 7 个，并在 2016 年 5 月至 2018 年 12 月期间根据相同的 24 至 38 岁年龄范围、7 至 18 个卵母细胞的相同数量范围以及根据临床卵巢刺激方案选择的 3:7 比例，随机选择了 103 例对照病例。通过 Wilcoxon 秩和检验和两独立样本 t 检验比较两组间年龄、基础内分泌状态、卵母细胞数、卵子成熟率、2PN 受精率、3PN 率、总受精率、卵裂率、D3 期 8 细胞胚胎率和胚胎利用率等几个参数。
尽管年龄范围为 24 至 38 岁，卵母细胞数为 7 至 18 个，但与对照组相比，实验组采集的卵母细胞数较少（9.455 对 10.767，p=0.016），年龄较小（28.36 对 32.59，p=0.000），基础内分泌状态 FSH 较高（9.783 对 7.338，p=0.021）。两组间成熟卵母细胞数（7.05 对 7.92，p=0.079）、成熟卵母细胞率（74.189%对 73.916%，p=0.924）、2PN 数（5.36 对 5.91，p=0.236）、2PN 率（73.678%对 75.125%，p=0.769）、3PN 数（0.39 对 0.50，p=0.773）、3PN 率（5.104%对 5.592%，p=0.697）、总受精数（6.77 对 7.35，p=0.241）、总受精率（96.461%对 93.166%，p=0.332）、卵裂率（82.003%对 81.382%，p=0.673）、D3 期 8 细胞数（1.59 对 1.91，p=0.227）、D3 期 8 细胞率（36.259%对 41.084%，p=0.551）和胚胎利用率（62.853%对 61.824%，p=0.806）无显著差异。
这些发现表明，对于 AMH 水平较低且卵母细胞数量理想的患者，尽管基础 FSH 较高，卵母细胞采集数量相对较少，且可能存在卵巢储备减少（DOR）或反应不良（PR）的风险，但她们的卵子成熟度和胚胎质量没有显著差异，仍应尽快进行 IVF 治疗并实现妊娠成功。
