Reis Ana Braga, Leal Carla, Barreiro Márcia, Tomé António, Vale-Fernandes Emídio
Unidade de Saúde Familiar Porta do Sol, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal.
JBRA Assist Reprod. 2024 Dec 3;28(4):597-603. doi: 10.5935/1518-0557.20240049.
To evaluate the correlation between serum anti-Müllerian hormone (AMH) and the number of oocytes retrieved after controlled ovarian stimulation for in vitro fertilization treatments and determine cut-off values predictive of poor and high response to stimulation.
It was performed a retrospective observational study that included 1003 cycles of controlled ovarian stimulation carried between February 2017 and December 2023 at a Medically Assisted Procreation Centre. The exclusion criteria were the following: serum AMH levels obtained more than 6 months prior to the start of the ovarian stimulation, the presence of a single ovary, non-Caucasian ethnicity, a controlled ovarian stimulation cycle performed for the purpose of oocyte donation or fertility preservation, a documented diagnosis of endometriosis, a documented history of ovarian surgery and the absence of essential data for the study in the medical records (absence of the number of oocytes obtained or the AMH value). Poor response to stimulation was defined as ≤ 3 oocytes retrieved, and high response was defined as > 15 oocytes. The correlation between variables was calculated using Spearman's correlation test and cut-off values were determined using ROC (Receiver Operating Characteristic) curves.
AMH exhibited a significantly positive correlation with the number of oocytes retrieved (Spearman's correlation coefficient = 0.60, p<0.01). The predictive cut-off for poor ovarian response was 0.72 ng/mL (specificity of 95.13%, sensitivity of 43.23%), and the predictive cut-off for high ovarian response was 4.77 ng/mL (specificity of 89.86%, sensitivity of 38.22%).
Serum AMH proved to be a good predictor of the ovarian response to controlled ovarian stimulation for in vitro fertilization treatments, which makes it useful in supporting clinical decision-making. However, it should not be used as an absolute discriminator of poor or high ovarian response.
评估体外受精治疗中控制性卵巢刺激后血清抗苗勒管激素（AMH）与获卵数之间的相关性，并确定预测刺激反应不良和高反应的临界值。
进行了一项回顾性观察研究，纳入了2017年2月至2023年12月在一家辅助生殖中心进行的1003个控制性卵巢刺激周期。排除标准如下：卵巢刺激开始前6个月以上获得的血清AMH水平、单卵巢存在、非白种人种族、为卵母细胞捐赠或生育力保存目的进行的控制性卵巢刺激周期、记录在案的子宫内膜异位症诊断、记录在案的卵巢手术史以及病历中缺乏研究所需的基本数据（未获得卵母细胞数量或AMH值）。刺激反应不良定义为获卵数≤3个，高反应定义为获卵数>15个。使用Spearman相关检验计算变量之间的相关性，并使用ROC（受试者工作特征）曲线确定临界值。
AMH与获卵数呈显著正相关（Spearman相关系数=0.60，p<0.01）。卵巢反应不良的预测临界值为0.72 ng/mL（特异性为95.13%，敏感性为43.23%），卵巢反应高的预测临界值为4.77 ng/mL（特异性为89.86%，敏感性为38.22%）。
血清AMH被证明是体外受精治疗中控制性卵巢刺激卵巢反应的良好预测指标，有助于支持临床决策。然而，它不应被用作卵巢反应不良或高反应的绝对判别指标。
