血清 AMH 和窦卵泡计数差异对 Poseidon 标准患者卵巢刺激反应预测的意义。
Significance of serum AMH and antral follicle count discrepancy for the prediction of ovarian stimulation response in Poseidon criteria patients.
机构信息
Department of Obstetrics and Gynecology, McGill University, 845 Rue Sherbrooke, O, Montreal, QC, 3HA 0G4, Canada.
The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
J Assist Reprod Genet. 2024 Mar;41(3):717-726. doi: 10.1007/s10815-024-03050-8. Epub 2024 Feb 15.
PURPOSE
To determine the risk of not being a poor responder in ovarian stimulation (OS) for in vitro fertilization (IVF) when ovarian reserve markers are discordant-one falling within Poseidon's criteria normal range (e.g., anti-Müllerian hormone (AMH) ≥ 1.2 ng/mL or antral follicle count (AFC) ≥ 5), and the other in the poor ovarian reserve range.
METHODS
A tri-center retrospective cohort study (2015-2017) involving women with discordant AMH and AFC values undergoing their first IVF/ICSI cycle using conventional OS (cOS, ≥ 150 IU/day of follicle-stimulating hormone). Discordant serum AMH and AFC values were defined according to Poseidon's criteria (AMH < 1.2 ng/mL and AFC ≥ 5 or AMH ≥ 1.2 ng/mL and AFC < 5). Poor ovarian response (POR) was < 4 retrieved oocytes. Receiver operating characteristic (ROC) curves were used to determine AMH and AFC cut-offs for non-POR. Logistic regression analysis evaluated factors associated with non-POR.
RESULTS
Out of 8797 patients who underwent assessment with both AMH and AFC, 1172 (13.3%) exhibited discordant values. Of these, 854 (72.9%) had ≥ 4 oocytes retrieved. Within this group, 726 (85.0%) had "low" AMH values, whereas 128 (15.0%) had "low" AFCs. An AFC of 6 had 77% sensitivity and 52% specificity (AUC = 0.700), while AMH of 1.19 ng/mL had 31% sensitivity and 85% specificity (AUC = 0.492) for non-POR. AFC and the use of recombinant gonadotropins were positive predictors of non-POR.
CONCLUSIONS
When serum AMH is < 1.19 ng/mL, but AFC is ≥ 6, there is a moderate likelihood of a non-POR during stimulation. Conversely, if AFC is < 5 but serum AMH is ≥ 1.19 ng/mL, the chances of non-POR are low. Among patients with discordant markers, AFC emerges as the primary predictor of oocyte yield.
目的
当卵巢储备标志物不一致时，即一个标志物在波塞冬标准正常范围内（如抗苗勒管激素（AMH）≥1.2ng/ml 或窦卵泡计数（AFC）≥5），而另一个标志物在卵巢储备不良范围内，确定体外受精（IVF）卵巢刺激（OS）中不受精的风险。
方法
这是一项涉及在接受常规 OS（≥150IU/天卵泡刺激素）的情况下进行首次 IVF/ICSI 周期的血清 AMH 和 AFC 值不一致的妇女的三中心回顾性队列研究（2015-2017 年）。根据波塞冬标准（AMH<1.2ng/ml 和 AFC≥5 或 AMH≥1.2ng/ml 和 AFC<5）定义血清 AMH 和 AFC 值不一致。POR 定义为取卵数<4 个。使用受试者工作特征（ROC）曲线确定非 POR 的 AMH 和 AFC 截断值。逻辑回归分析评估与非 POR 相关的因素。
结果
在接受 AMH 和 AFC 评估的 8797 名患者中，有 1172 名（13.3%）存在不一致的数值。其中 854 名（72.9%）取卵数≥4 个。在这一组中，726 名（85.0%）AMH 值较低，而 128 名（15.0%）AFC 值较低。AFC 为 6 时，灵敏度为 77%，特异性为 52%（AUC=0.700），而 AMH 为 1.19ng/ml 时，灵敏度为 31%，特异性为 85%（AUC=0.492）非 POR。AFC 和重组促性腺激素的使用是非 POR 的阳性预测因素。
结论
当血清 AMH<1.19ng/ml 但 AFC≥6 时，刺激期间不受精的可能性中等。相反，如果 AFC<5 但血清 AMH≥1.19ng/ml，不受精的可能性较低。在标志物不一致的患者中，AFC 是卵母细胞产量的主要预测因素。
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