降调节后血清抗苗勒管激素水平预测控制性超排卵临床结果的意义  

The predictive value of serum anti - Müllerian hormone level after Down - regulation on controlled ovarian stimulation clinical outcome

作　　者：叶云[1] 吴日然[1] 林晓丽[1] 吴嘉齐[1] 张旭宾[1] 黄美玲[1] 

机构地区：[1]广东省中山市博爱医院生殖中心,广东528403

出　　处：《中国优生与遗传杂志》2013年第8期131-135,共5页Chinese Journal of Birth Health & Heredity

基　　金：广东省医学科研基金项目;项目编号:A2011747

摘　　要：目的探讨降调节后血清抗苗勒氏管激素(AMH)水平预测控制性超排卵临床结果的意义。方法选择2012年2～9月在本中心行体外受精/胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)的使用统一黄体期长效长方案的"标准病人"的128个周期。降调前月经来潮第2-5天和降调后14天分别抽取空腹静脉血检测AMH、促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2),抽血当天行阴道B超检查窦卵泡计数(AFC)。按卵巢高中低反应分组,比较降调前后AMH、AFC、FSH、LH、FSH/LH、E2在各组间的差异。按降调后血清AMH水平分为三组,1组:≤1.87μg/L,2组:1.88～3.57μg/L,3组:≥3.58μg/L,比较各组年龄、总促性腺激素(GnH)用量、获卵数、受精数、卵裂数、可利用胚胎数、妊娠结局有无差异。分析控制年龄因素后降调前后AMH、AFC、FSH、LH、FSH/LH、E2与总GnH用量、获卵数、受精数、卵裂数、可利用胚胎数、妊娠结局的相关性。结果 1.降调后AMH在卵巢低、中、高反应组中的平均值分别为(1.09±0.60)μg/L、(2.48±1.19)μg/L、(4.09±2.10)μg/L,不同反应组间两两比较,只有降调后AMH、降调前AFC和降调后AFC这三个指标在三组间均有统计学差异(P<0.05)。总GnH量在低反应组是多于高反应组的(P<0.05)。2.按降调后AMH分组,1组和3组比较总GnH剂量、获卵数、受精数、卵裂数、可利用胚胎数均有差异(P<0.01)。1组和2组比较除总GnH量没有差异外,获卵数、受精数、卵裂数、可利用胚胎数均有差异(P<0.01)。2组和3组受精数、卵裂数、可利用胚胎数无差异(P>0.05),获卵数和总GnH量有差异(P<0.05)。3.与获卵数相关性由强到弱是降调后AMH、降调后AFC、降调前AFC、基础AMH、基础FSH/LH。与受精数和卵裂数相关性由强到弱是降调后AMH、降调后AFC、降调前AFC。与可利用胚胎数相关的只有降调后AMH、降调后AFC。与妊娠结局相关的只有降调后AMH。降调后AMH与获卵数�Objective： To investigate the predictive value of serum anti - müllerian hormone （ AMH） level after down - regulation on controlled ovarian stimulation （ COS） clinical outcomes. Methods： Patients who accepted the IVF / ICSI - ET from 2012 February to September in our center were recruited. Inclusion criteria as following： age≤38 years old （ 22 ～ 38 years） ,with regular spontaneous menstrual cycles （ 21 ～ 35 days） ,normal basal serum follicle - stimulating hormone （ FSH） level （ FSH 10IU / L） ,body mass index （ BMI） in 18 ～23,underwent luteal phase long protocol. 128 cycles was selected. Serum AMH level was measured at baseline and Day 14 following GnRH - a. Antral follicles count （ AFC） and the levels of serum FSH,luteinizing hormone （ LH） ,estradiol （ E 2 ） were also determined at the same time. These patients were classified into 3 groups including poor response （ oocytes retrieved≤5） , normal response （ oocytes retrieved 5 - 15） ,and high response （ oocytes retrieved≥16） according to ovarian response in COS. The serum level of AMH,FSH,LH,E 2 ,FSH/LH and AFC before and after down - regulation between each group were compared. According to the serum AMH level after down - regulation,patients were divided into three groups： group 1∶ ≤1. 87μg / L,group 2∶ 1. 88 - 3. 57μg / L,group 3∶ ≥3. 58μg / L. The difference of clinical outcomes between the three groups were compared. Controlling factor of age,the correlation analysis between the predictors and total gonadotropin hormone （ GnH） dose,number of oocytes retrieved, number of fertilizations,number of cleavages,number of available embryos,pregnancy outcomes was done. Results： 1. The average level of serum AMH after down - regulation in ovarian poor response,normal response,and high response was （ 1. 09 ± 0. 60） μ g / L,（ 2. 48 ± 1. 19） μ g / L,（ 4. 09 ± 2. 10） μ g / L respectively. Comparison of the three groups above,the serum AMH after down -regulation,bas

关 键 词：抗苗勒管激素 降调节 控制性超排卵 体外受精 胞浆内单精子注射-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]