Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People's Republic of China.
Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Eur J Med Res. 2024 Mar 12;29(1):167. doi: 10.1186/s40001-024-01768-w.
Recent studies about the effect of gonadotropin (Gn) dose on the clinical outcomes of IVF are still controversial, and no studies have analyzed the relationship between Gn dose and embryo quality. Since AMH is a strong predictor of oocyte quality, we aim to evaluate the relationship between total Gn dose and embryo quality and clinical outcomes at different AMH levels in IVF cycles.
A total of 12,588 patients were enrolled in the retrospective study. The included cycles were categorized by serum AMH levels (AMH ≤ 1 ng/ml, 1 ng/ml < AMH ≤ 3 ng/ml, 3 ng/ml < AMH ≤ 5 ng/ml, AMH > 5 ng/ml), total Gn dosage (< 1875 IU, 1875-3750 IU and ≥ 3750 IU) and female age (< 35 years and 35-42 years). The embryo quality and clinical outcomes were the measure outcomes.
The top-day3 embryos rate decreased with the increase of total Gn dose in nearly all age and AMH subgroups, but this trend was not obvious in the AMH > 5 ng/ml group and AMH ≤ 1 ng/ml group. The blastocyst formation rate and high-quality blastulation rate had a negative relationship with Gn does for women aged < 35 years in the AMH ≤ 5 ng/ml groups, except for the AMH > 5 ng/ml group (P < 0.001). However, when women were 35-42 years old, regardless of AMH levels, the blastocyst formation rate and high-quality blastulation rate decreased as Gn dose increased. Clinical outcomes (implantation rate, clinical pregnancy rate and live birth rate) decreased with the increase of Gn dose in all ages and AMH stratifications.
The total dose of Gn may have different effects on embryo quality at different serum AMH levels, and the negative effects of total dose of Gn on clinical outcomes may be realized by impairing both embryo quality and endometrium.
最近关于促性腺激素（Gn）剂量对体外受精临床结局影响的研究仍存在争议，且尚无研究分析 Gn 剂量与胚胎质量之间的关系。由于 AMH 是卵母细胞质量的强有力预测指标，我们旨在评估在不同 AMH 水平的 IVF 周期中，Gn 总剂量与胚胎质量和临床结局之间的关系。
本回顾性研究共纳入 12588 名患者。根据血清 AMH 水平（AMH≤1ng/ml、1ng/ml<AMH≤3ng/ml、3ng/ml<AMH≤5ng/ml、AMH>5ng/ml）、Gn 总剂量（<1875IU、1875-3750IU 和≥3750IU）和女性年龄（<35 岁和 35-42 岁）对纳入的周期进行分类。胚胎质量和临床结局为测量指标。
在几乎所有年龄和 AMH 亚组中，随着 Gn 总剂量的增加，第 3 天优质胚胎率降低，但在 AMH>5ng/ml 组和 AMH≤1ng/ml 组中这种趋势并不明显。对于 AMH≤5ng/ml 组中年龄<35 岁的女性，除 AMH>5ng/ml 组外（P<0.001），囊胚形成率和优质囊胚形成率与 Gn 剂量呈负相关。然而，当女性年龄为 35-42 岁时，无论 AMH 水平如何，随着 Gn 剂量的增加，囊胚形成率和优质囊胚形成率均降低。在所有年龄和 AMH 分层中，临床结局（种植率、临床妊娠率和活产率）均随 Gn 剂量的增加而降低。
Gn 的总剂量在不同血清 AMH 水平下可能对胚胎质量产生不同的影响，Gn 总剂量对临床结局的负面影响可能是通过损害胚胎质量和子宫内膜来实现的。
