Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA.
Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
J Assist Reprod Genet. 2021 Jul;38(7):1827-1833. doi: 10.1007/s10815-021-02217-x. Epub 2021 May 1.
To assess whether anti-Müllerian hormone (AMH) can predict response to ovulation induction (OI) with clomiphene citrate (CC), letrozole (LET), or follicle-stimulating hormone (FSH) in women with polycystic ovary syndrome (PCOS) undergoing OI/intrauterine inseminations (IUI).
A total of 738 OI/IUI cycles from 242 patients at an academic center were stratified in three groups by medication: CC (n = 295), LET (n = 180), and FSH (n = 263), in a retrospective fashion. Ovarian response to treatment (RT, development of at least one dominant follicle) was assessed using mixed effects logistic regression models.
Overall, RT cycles had lower AMH levels compared to no-RT cycles (p < 0.001). This finding persisted when analysis was limited to oral agents but attenuated in FSH cycles. For CC and LET cycles, the predicted probability (PProb) for RT decreased as AMH levels increased (PProb (95%CI): 97% (93-100), 79% (70-88), and 75% (61-89); 85% (78-93), 75% (67-83), and 73% (63-86) for AMH pct.: ≤ 25th, ≥ 50th, and ≥ 75th, for CC and LET, respectively)). However, RT was noted in 98.5% of FSH/IUI cycles regardless of AMH. For CC cycles, those with AMH ≥ 75th pct. had lower odds for RT over cycles with AMH < 75th pct. (OR 0.2, 95%CI 0.04-0.8, p = 0.02). Similarly, lower odds for RT were observed in LET cycles with AMH ≥ 75th pct. (0.6, 0.3-1.4, p = 0.25).
In PCOS, increasing serum AMH levels are associated with lower probability of RT to oral agents. Our findings constitute a valuable tool for the clinician when counseling PCOS patients and designing a personalized ovulation induction treatment strategy.
评估抗苗勒管激素（AMH）能否预测多囊卵巢综合征（PCOS）患者接受氯米芬（CC）、来曲唑（LET）或卵泡刺激素（FSH）诱导排卵（OI）/宫腔内人工授精（IUI）时的反应。
回顾性分析 242 名患者在学术中心进行的 738 个 OI/IUI 周期，按药物分为三组：CC（n = 295）、LET（n = 180）和 FSH（n = 263）。使用混合效应逻辑回归模型评估治疗反应（RT，至少发育一个优势卵泡）。
总体而言，RT 周期的 AMH 水平低于非 RT 周期（p < 0.001）。当仅分析口服药物时，这一发现仍然存在，但在 FSH 周期中减弱。对于 CC 和 LET 周期，随着 AMH 水平的升高，RT 的预测概率（PProb）降低（PProb（95%CI）：97%（93-100）、79%（70-88）和 75%（61-89）；85%（78-93）、75%（67-83）和 73%（63-86），对于 AMH pct.：≤ 25th、≥ 50th 和≥ 75th，分别用于 CC 和 LET）。然而，无论 AMH 水平如何，98.5%的 FSH/IUI 周期都进行了 RT。对于 CC 周期，AMH ≥ 75%pct.的周期进行 RT 的可能性低于 AMH < 75%pct.的周期（OR 0.2，95%CI 0.04-0.8，p = 0.02）。同样，在 AMH ≥ 75%pct.的 LET 周期中，RT 的可能性也较低（0.6，0.3-1.4，p = 0.25）。
在 PCOS 中，血清 AMH 水平升高与接受口服药物治疗的反应概率降低相关。我们的发现为临床医生在为 PCOS 患者提供咨询和制定个体化的排卵诱导治疗策略时提供了有价值的工具。
