自然周期、微刺激和常规体外受精方案中卵巢反应与抗苗勒管激素水平的关系——一项多中心研究。

Ovarian response in natural cycle, minimal stimulation and conventional IVF protocols in relation to anti-mullerian hormone level - A multi-center study.

作者信息

Magaton I, Arni A, von Arnim L, Nordin M, Siercks I, Popovici R M, Bohlen U, Eisenhardt S, Reeka N, Lanowski J-S, Lühr B, Roumet M, von Wolff M

机构信息

Division of Gynaecological Endocrinology and Reproductive Medicine, University Women s Hospital, Inselspital, Friedbühlstrasse 19, 3010 Bern, Switzerland.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2025 Aug 22;314:114668. doi: 10.1016/j.ejogrb.2025.114668.

DOI:10.1016/j.ejogrb.2025.114668

PMID:40876402

Abstract

BACKGROUND

In addition to conventional in-vitro-fertilization IVF (cIVF) alternative protocols such as natural cycle (NC-) and minimal stimulation (Min stim-) protocols allow individualized IVF and oocyte freezing treatments. The objective was to develop a model to predict ovarian response in relation to different stimulation protocols and anti-mullerian hormone (AMH) levels.

METHODS

International multi-centre retrospective cohort study including 1504 NC-IVF, 1287 Min stim IVF and 2048 cIVF cycles performed 01.2022-03.2023. Min stim protocols consisted of oral compounds such as low dose clomiphene citrate or aromatase inhibitors alone or in combination with low dose gonadotropins. Negative binomial regression models were used to assess the effect of protocol and AMH level on the number of oocytes and secondarily on zygotes. Predictions of outcomes were derived across protocols and different AMH categories (<1, ≥1-<2, ≥2 ng/ml).

RESULTS

AMH is an effective predictor of the number of oocytes in relation to IVF protocol. Number of oocytes increase in protocols including gonadotropins, but not in protocols with only oral compounds. Effect of stimulation increased with increasing AMH level but was less pronounced with low AMH level. For example, if AMH is < 1 ng/ml, the predicted number of oocytes is 0.85 and 4.04 in the NC- and cIVF protocols, whereas the difference is twice as large with AMH ≥ 2 ng/ml with predicted values of 0.83 and 10.54, respectively.

CONCLUSION

Based on AMH level, Min stim-protocols can be individualized by selecting specific stimulation protocols according to the predicted ovarian response, especially in cases with low ovarian reserve.

摘要

背景

除了传统的体外受精（cIVF），自然周期（NC-）和微刺激（Min stim-）方案等替代方案允许进行个体化的体外受精和卵母细胞冷冻治疗。目的是开发一个模型，以预测与不同刺激方案和抗苗勒管激素（AMH）水平相关的卵巢反应。

方法

国际多中心回顾性队列研究，纳入了2022年1月至2023年3月期间进行的1504个NC-IVF周期、1287个Min stim IVF周期和2048个cIVF周期。Min stim方案由口服化合物组成，如单独使用低剂量枸橼酸氯米芬或芳香化酶抑制剂，或与低剂量促性腺激素联合使用。采用负二项回归模型评估方案和AMH水平对卵母细胞数量的影响，其次评估对受精卵数量的影响。在不同方案和不同AMH类别（<1、≥1-<2、≥2 ng/ml）中得出结果预测。

结果

AMH是与体外受精方案相关的卵母细胞数量的有效预测指标。在包括促性腺激素的方案中，卵母细胞数量增加，但在仅使用口服化合物的方案中则不然。刺激效果随着AMH水平的升高而增加，但在低AMH水平时不太明显。例如，如果AMH<1 ng/ml，NC-和cIVF方案中预测的卵母细胞数量分别为0.85和4.04，而当AMH≥2 ng/ml时，差异是前者的两倍，预测值分别为0.83和10.54。