抗苗勒管激素水平为 0.3ng/mL 或更低的不孕女性的活产结局。

Live-Birth Outcomes Among Women With Infertility and Anti-Müllerian Hormone Levels of 0.3 ng/mL or Lower.

机构信息

Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York.

出版信息

Obstet Gynecol. 2022 Nov 1;140(5):743-750. doi: 10.1097/AOG.0000000000004895. Epub 2022 Oct 5.

DOI:10.1097/AOG.0000000000004895

PMID:36201783

Abstract

OBJECTIVE

To estimate the live-birth rate per in vitro fertilization (IVF) cycle and after cumulative infertility treatment among patients with anti-müllerian hormone (AMH) levels of 0.3 ng/mL or lower.

METHODS

We conducted a retrospective cohort study at a single academic center of patients with infertility and AMH levels of 0.3 ng/mL or lower who initiated one or more IVF cycles (2013-2019). Exclusion criteria included prior chemotherapy, hormonal contraceptive use within 3 months of AMH level measurement, and severe male factor infertility. Patients were stratified by Society for Assisted Reproductive Technology (SART) age group. The primary outcome was live-birth rate per IVF cycle. Live-birth outcomes were compared with the 2018 SART National Summary Report for live births per single intended oocyte retrieval, with proportion difference (PD) and 95% CI reported.

RESULTS

A total of 978 patients were included. The median (interquartile range) number of cycles initiated was 2 (1-3). With the first initiated cycle, the live-birth rate for those with AMH levels of 0.3 ng/mL or lower was significantly lower in each age category compared with the SART live-birth rate per single initiated cycle (younger than 35 years: 26.2% vs 55.6%, PD 29.4%, 95% CI 20.9-37.9%; 35-37 years: 15.9% vs 40.8%, PD 24.9%, 95% CI 19.0-30.9%; 38-40 years: 12.6% vs 26.8%, PD 14.3%, 95% CI 10.2-18.3%; 41-42 years: 4.7% vs 13.4%, PD 8.7%, 95% CI 5.9-11.6%; older than 42 years: 1.2% vs 4.1%, PD 2.9%, 95% CI 1.5-4.3%). In patients aged 35-37, 38-40, 41-42, and older than 42 years, the cumulative live-birth rate after up to three initiated cycles was comparable with the SART live-birth rate per single initiated cycle but remained significantly lower in patients younger than age 35 years (PD 16.8%, 95% CI 7.3-26.2%). After all treatments were included (cumulative IVF, ovulation induction, and unassisted cycles), live-birth rates were similar to SART live-birth rates per single initiated cycle in all age groups.

CONCLUSION

Compared with national outcomes, patients with AMH levels of 0.3 ng/mL or lower had a significantly lower chance of live birth after their first initiated cycle. However, the cumulative live-birth rate after up to three initiated cycles was comparable with national live-birth outcomes per single initiated cycle in patients aged 35 years or older. In patients younger than age 35 years, only when all IVF and non-IVF treatment cycles were included did the cumulative live-birth rate become comparable with the national rate per single IVF cycle.

摘要

目的

评估抗苗勒管激素（AMH）水平为 0.3ng/ml 或更低的患者每个体外受精（IVF）周期及累积不孕治疗后的活产率。

方法

我们在一个学术中心进行了一项回顾性队列研究，纳入了 AMH 水平为 0.3ng/ml 或更低且启动了一个或多个 IVF 周期（2013-2019 年）的不孕患者。排除标准包括先前接受过化疗、AMH 水平测量前 3 个月内使用激素避孕药，以及严重的男性因素不孕。患者按辅助生殖技术协会（SART）年龄组分层。主要结局为每个 IVF 周期的活产率。将活产结局与 2018 年 SART 国家总活产率报告中单取卵周期的活产率进行比较，报告比例差异（PD）和 95%置信区间（CI）。

结果

共纳入 978 例患者。中位数（四分位距）启动周期数为 2（1-3）个。对于 AMH 水平为 0.3ng/ml 或更低的患者，与 SART 单周期启动后的活产率相比，每个年龄组的首次启动周期活产率均显著降低（年龄小于 35 岁：26.2%比 55.6%，PD 29.4%，95%CI 20.9-37.9%；35-37 岁：15.9%比 40.8%，PD 24.9%，95%CI 19.0-30.9%；38-40 岁：12.6%比 26.8%，PD 14.3%，95%CI 10.2-18.3%；41-42 岁：4.7%比 13.4%，PD 8.7%，95%CI 5.9-11.6%；年龄大于 42 岁：1.2%比 4.1%，PD 2.9%，95%CI 1.5-4.3%）。在年龄 35-37 岁、38-40 岁、41-42 岁和年龄大于 42 岁的患者中，最多启动三个周期后的累积活产率与 SART 单周期启动后的活产率相当，但年龄小于 35 岁的患者仍显著降低（PD 16.8%，95%CI 7.3-26.2%）。纳入所有治疗（累积 IVF、促排卵和非辅助周期）后，所有年龄组的活产率与 SART 单周期启动后的活产率相似。

结论

与国家结果相比，AMH 水平为 0.3ng/ml 或更低的患者在首次启动周期后的活产机会显著降低。然而，在年龄 35 岁或以上的患者中，最多启动三个周期后的累积活产率与国家单周期启动后的活产率相当。在年龄小于 35 岁的患者中，只有在纳入所有 IVF 和非 IVF 治疗周期后，累积活产率才与国家单周期 IVF 周期的活产率相当。