输卵管积水和阻塞患者的试管婴儿结局及与血清抗苗勒氏管激素的关系  

Association between serum anti-Mullerian hormone levels and IVF-ET outcomes in infertile women with salpingemphraxis

作　　者：应映芬[1] 黄朝霞[1] 陈益鲁[1] 王琳[2] 吕杰强[1] 赵军招[1] YING Yingfen HUANG Zhaoxia CHEN Yilu et al(Reproductive Medicine Center, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Chin)

机构地区：[1]温州医科大学附属第二医院生殖中心,325027 [2]浙江大学医学院附属妇产科医院生殖内分泌科

出　　处：《浙江医学》2017年第10期782-785,共4页Zhejiang Medical Journal

基　　金：温州市科技局科技计划项目(Y 20150213)

摘　　要：目的探讨输卵管积水与阻塞患者的试管婴儿结局及与血清抗苗勒氏管激素(AMH)的相关性。方法选取因输卵管性不孕行体外受精-胚胎移植(IVF-ET)的不孕患者160例,分为积水组(输卵管阻塞合并积水54例)和阻塞组(单纯输卵管阻塞106例)。采用ELISA法测定血清AMH水平。观察并比较两组患者的AMH水平、给予促性腺激素(Gn)天数及剂量、获卵数、成熟卵子数、受精数、卵裂数、可用胚胎数、D3优胚率、囊胚形成率等指标,并分析AMH水平与Gn天数、Gn剂量、获卵数、成熟卵子数、受精数、卵裂数、可用胚胎数、D3优胚率、囊胚形成率以及临床妊娠率之间的关系。结果积水组Gn剂量明显高于阻塞组,差异有统计学意义(P<0.05);积水组D3优胚率和临床妊娠率明显低于阻塞组,差异均有统计学意义(均P<0.05)。积水组和阻塞组血清AMH表达水平比较差异无统计学意义(P>0.05)。积水组和阻塞组AMH水平与年龄、Gn剂量均呈负相关(r=-0.083,P=0.028 vs r=-0.382,P=0.005;r=-0.444,P=0.020 vs r=-0.573,P=0.001),与获卵数呈正相关(r=0.385,P=0.047 vs r=0.295,P=0.032);积水组和阻塞组AMH水平与D3优胚率、囊胚形成率以及临床妊娠率均无相关性(均P>0.05)。结论输卵管积水患者在IVF-ET过程中需要消耗更多的Gn且临床妊娠率降低,因此在IVF-ET治疗前应积极处理输卵管积水,但输卵管积水不会明显影响卵巢功能以及血清AMH水平,AMH水平可以预测此类患者IVF-ET超促排卵中的Gn用量及获卵情况,但不能预测胚胎质量及试管婴儿结局。Objective To investigate the association between serum anti-Mullerian hormone （AMH） levels and in vitro fertilization-embryo transfer （IVF-ET） outcomes in infertile women with salpingemphraxis and hydrosatpinx. Methods One hundred and sixty salpingemphraxis infertile females undergoing tVF-ET were enrolled in the study, including 106 women with simple salpingemphraxis （satpingemphraxis group） and 54 women with salpingemphraxis and hydrosalpinx（hydrosalpinx group）. Serum AMH levels were measured by ELISA method and compared between two groups, and between those with different IVF-ET outcomes. Results Gn dosage was significantly higher in hydrosalpinx group than that in salpingemphraxis group （P〈 0.05）. The D3 quality embryo rate and pregnancy rate in hydrosalpinx group was significantly lower than those in salpingemphraxis group （P〈0.05）. There was no significant difference in serum AMH levels between two groups （P 〉0.05）. Serum AMH level was negatively correlated with age and Gn dose in two groups（r =-0.083, P=0.028 and r =-0.382, P=0.005, r =-0.444, P=0.020 and r=-0.573, P=0.001）, and positively correlated with the number of retrieved oocytes in two groups （r=0. 385, P=0.047 and r =0.295, P=0.032）. There was no association of serum AMH levels with the D3 quality embryo rate, blastocyst rate and clinical pregnancy rate in two groups （all P 〉0.05）. Conclusion Hydrosalpinx patients need more Gn but with reduced clinical pregnancy rate in IVF-ET. Hydrosalpinx has no significant affect on ovarian function and serum AMH level. AMH level may predict Gn dosage and the number of retrieved oocytes in patients with hydrosalpinx during controlled ovarian stimulation, and can＇t refer to the quality of embryos and IVF-ETs clinical outcomes.

关 键 词：输卵管性不孕 输卵管阻塞 输卵管积水 抗苗勒氏管激素 体外受精-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]