Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Endocrinol (Lausanne). 2022 Jun 23;13:796199. doi: 10.3389/fendo.2022.796199. eCollection 2022.
Women with diminished ovarian reserve (DOR) have a lower pregnancy rate and higher cancellation rate compared to those without DOR when seeking assisted reproductive technology. However, which factors are associated with reproductive outcomes and whether AMH is a predictor of clinical pregnancy remain unclear.
This retrospective study was designed to find factors associated with reproductive outcomes in DOR patients and then discuss the role of AMH in predicting cycle results among this population.
A total of 900 women were included in the study. They were diagnosed with DOR with the following criteria: (i) FSH > 10 IU/L; (ii)AMH < 1.1 ng/ml; and (iii) AFC <7. They were divided into different groups: firstly, based on whether they were clinically pregnant or not, pregnant group vs. non-pregnant group (comparison 1); secondly, if patients had transferrable embryos (TE) or not, TE vs. no TE group (comparison 2); thirdly, patients undergoing embryo transfer (ET) cycles were divided into pregnant I and non-pregnant I group (comparison 3). The baseline and ovarian stimulation characteristics of these women in their first IVF/ICSI cycles were analyzed. Logistic regression was performed to find factors associated with clinical pregnancy.
Of the 900 DOR patients, 138 women got pregnant in their first IVF/ICSI cycles while the rest did not. AMH was an independent predictor of TE after adjusting for confounding factors (adjusted OR:11.848, 95% CI: 6.21-22.62, P< 0.001). Further ROC (receiver operating characteristic) analysis was performed and the corresponding AUC (the area under the curve) was 0.679 (95% CI: 0.639-0.72, P< 0.001). Notably, an AMH level of 0.355 had a sensitivity of 62.6% and specificity of 65.6%. However, there was no statistical difference in AMH level in comparison 3, and multivariate logistic regression showed female age was associated with clinical pregnancy in ET cycles and women who were under 35 years old were more likely to be pregnant compared to those older than 40 years old (adjusted OR:4.755, 95% CI: 2.81-8.04, P< 0.001).
AMH is highly related to oocyte collection rate and TE rate,and 0.355 ng/ml was a cutoff value for the prediction of TE. For DOR patients who had an embryo transferred, AMH is not associated with clinical pregnancy while female age is an independent risk factor for it.
与非 DOR 患者相比，卵巢储备功能降低（DOR）的女性在接受辅助生殖技术时的妊娠率较低，取消率较高。然而，哪些因素与生殖结局相关，以及 AMH 是否是预测临床妊娠的指标仍不清楚。
本回顾性研究旨在寻找 DOR 患者生殖结局相关的因素，并讨论 AMH 在该人群预测周期结果中的作用。
共纳入 900 名符合以下标准的 DOR 女性：（i）FSH>10IU/L；（ii）AMH<1.1ng/ml；（iii）AFC<7。将她们分为不同的组：首先，根据是否临床妊娠，分为妊娠组和非妊娠组（比较 1）；其次，如果患者有可转移胚胎（TE），分为 TE 组和无 TE 组（比较 2）；第三，接受胚胎移植（ET）周期的患者分为妊娠 I 组和非妊娠 I 组（比较 3）。分析这些女性在首次 IVF/ICSI 周期中的基础和卵巢刺激特征。采用 logistic 回归分析寻找与临床妊娠相关的因素。
在 900 名 DOR 患者中，138 名女性在首次 IVF/ICSI 周期中妊娠，其余未妊娠。AMH 是 TE 的独立预测因素，调整混杂因素后（调整 OR：11.848，95%CI：6.21-22.62，P<0.001）。进一步进行 ROC（受试者工作特征）分析，对应的 AUC（曲线下面积）为 0.679（95%CI：0.639-0.72，P<0.001）。值得注意的是，AMH 水平为 0.355 时，灵敏度为 62.6%，特异性为 65.6%。然而，在比较 3 中 AMH 水平没有统计学差异，多因素 logistic 回归显示，女性年龄与 ET 周期的临床妊娠相关，年龄小于 35 岁的女性比年龄大于 40 岁的女性更有可能妊娠（调整 OR：4.755，95%CI：2.81-8.04，P<0.001）。
AMH 与卵母细胞采集率和 TE 率密切相关，0.355ng/ml 是 TE 预测的截断值。对于进行胚胎移植的 DOR 患者，AMH 与临床妊娠无关，而女性年龄是其独立的危险因素。
