多囊卵巢综合征患者在体外受精-胚胎移植中AMH的变化及影响  

Changes of anti-Mullerian hormone(AMH)and the correlation between outcomes in vitro fertilization-embryo transfer cycle in patients with polycystic ovary syndrome(PCOS)

作　　者：安锦霞[1] 刘小玲[1] 王琰[1] 倪亚莉[1] 温晓晓[1] 刘丽娟[1] AN Jin-xia;LIU Xiao-ling;WANG Yan;NI Ya- li;WEN Xiao-xiao;LIU Li-juan(Center of Reproductive Medicine Gansu Provincial Maternity and Child Health Care Hospital,Lanzhou,730050)

机构地区：[1]甘肃省妇幼保健院生殖医学中心

出　　处：《中国优生与遗传杂志》2018年第12期113-116,共4页Chinese Journal of Birth Health & Heredity

基　　金：甘肃省科技厅省级自然基金项目(1506RJZA160);兰州市科技局卫生专项基金项目(2016-2-51)

摘　　要：目的探讨抗苗勒氏管激素(AMH)在多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)周期治疗中的动态变化及对结局的预测价值。方法 PCOS组患者120例,对照组患者100例。两组分别按照体重指数(BMI)分为亚组肥胖组和非肥胖组。检测患者月经周期第2/3天(D2/3)、控制性超促排卵中降调节后第17天、促性腺激素(gonadotrophin,Gn)使用第5天(Gn5)及人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)扳机日(HCG日)血清AMH浓度,观察其动态变化及其对控制性超促排卵(controlled ovarian hyperstimulation,COH)结局的影响。结果在COH过程中,血清AMH浓度逐渐降低。PCOS组降调节后17天、Gn5天、HCG日的AMH值均显著高于对照组,差异有统计学意义(P<0.05)。PCOS组内比较,肥胖组降调节后17天、Gn5天、HCG日的AMH值均高于非肥胖组,差异有统计学意义(P<0.05)。PCOS组MII卵率、受精率、临床妊娠率及胚胎种植率均低于对照组,差异具有统计学意义(P<0.05);PCOS组中,AMH与获卵数呈正相关(P<0.05),与MII卵率、受精率、临床妊娠率无相关性(P >0.05)。结论 PCOS患者AMH在COH过程中呈现动态变化,可以预测COH中卵巢的反应性,但是对体外受精-胚胎移植结局的预测价值尚有待进一步研究。Objective:To study change of anti-mullerian hormone(AMH)and the predictive value of outcomes in vitro fertilization-embryo transfer(IVF-ET)cycle in patients with polycystic ovary syndrome(PCOS). Methods:120 patients in PCOS group and 100 patients in control group. The two groups were divided into subgroups(obese groups and non-obese groups)according to body mass index(BMI). AMH levels were measured in serum on menstrual cycle day 2 or 3(D2/3),day17(D-17)after pituitary down-regulation,day 5 of gonadotropin stimulation(Gn5),human chorionic gonadotropin(hCG)day(D-hCG)during IVF treatment,and the relationship of AMH levels with COH outcomes was analyzed. Results:Serum AMH concentration decreased gradually during COH. The AMH levels of D17,Gn5 days and HCG days in PCOS group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05). In the PCOS group,the AMH levels of D17,Gn5 days and HCG days were higher than those in the non-obese group,and the difference was statistically significant(P<0.05).The MII ovular rate,fertilization rate,clinical pregnancy rate and embryo planting rate of PCOS group were all lower than the control group,and the difference was statistically significant(P<0.05). In the PCOS group,AMH was positively correlated with the number of retrieved oocytes(P<0.05),no correlation with MII ovular rate,fertilization rate,and clinical pregnancy rate(P >0.05). Conclusion:Serum AMH levels is demonstrated to have dynamic changes during COH procedure in PCOS patients,and reflect the ovarian response in COH. The predictive value of AMH on COH outcomes in PCOS remains to be evaluated via further research.

关 键 词：多囊卵巢综合征 抗苗勒氏管激素 体外受精-胚胎移植 超促排卵 临床妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]