抗苗勒管激素和窦卵泡计数不相符对卵巢反应性的预测价值  

Predictive value of inconsistent level between anti-Mullerian hormone and antral follicle count in ovarian responsiveness

作　　者：卜晓萌 张巧利[1] 刘艳君[1] 贾婵维[1] 马延敏[1] 王树玉[1] BU Xiao-meng;ZHANG Qiao-li;LIU Yan-jun;JIA Chan-wei;MA Yan-min;WANG Shu-yu(Department of Reproductive Medicine,Beijing Gynecology&Obstetrics Hospital,Capital Medical University,Beijing 100026)

机构地区：[1]首都医科大学附属北京妇产医院生殖医学科,北京100026

出　　处：《生殖医学杂志》2021年第12期1558-1563,共6页Journal of Reproductive Medicine

基　　金：北京市医院管理中心临床技术创新项目(XMLX202122)。

摘　　要：目的评价体外受精治疗前血清抗苗勒管激素(AMH)水平和窦卵泡计数(AFC)不一致的患者卵巢反应和胚胎情况。方法选择2020年1月—11月首次在北京妇产医院生殖医学科接受体外受精/卵胞浆内单精子注射(IVF/ICSI)治疗的424例不孕患者,于月经周期的第2~3天检测血清AMH水平和AFC个数,并根据卵巢高低反应的血清AMH水平和AFC截断值将患者分为9组,比较各组的获卵数和可移植胚胎数。结果137例患者(第2、4、6、7、8组)出现不一致的AFC和AMH水平,占比32.3%(137/424)。AFC值相同而AMH水平不同的组间比较,发现AMH较高组(第1组对第4组、第2组对第5组、第5组对第8组、第6组对第9组)有较高的获卵率及可移植胚胎率,差异有统计学意义(P<0.05)。AMH和AFC水平不一致的组间比较,卵巢储备功能偏低人群的血清AMH水平较高组比AFC较高组(第2组对第4组)有更高的获卵数及可移植胚胎数,而卵巢储备功能较好人群的AFC较高组比血清AMH水平较高组(第6组对第8组)有更高的获卵数及可移植胚胎数,差异均有统计学意义(P<0.05)。结论当AMH和AFC不一致时,卵巢反应性介于两者一致时的卵巢高低反应之间。当卵巢储备偏低时,AMH更有预测价值;而卵巢储备较高时,AFC则更有预测价值。Objective:To evaluate the ovarian response and embryo status of patients with inconsistent level between serum anti-Mullerian hormone(AMH)and antral follicle count(AFC)before IVF.Methods:A total of 424 infertile women who underwent the first IVF/ICSI cycle in the Department of Reproductive Medicine,Beijing Gynecology and Obstetrics Hospital affiliated,Capital Medical University from Jan.to Nov.2020 were enrolled in this study.The serum AMH level and AFC were determined on the 2^(nd) to 3^(rd) day of menstrual cycle.The patients were divided into groups according to the cutoff value of serum AMH level and AFC.The numbers of retrieved oocytes and transplantable embryos were compared among the groups.Results:Among 424 patients,137 patients(groups 2,4,6,7 and 8)had inconsistent level between AMH and AFC,accounting for 32.3%(137/424).The comparison among the groups with the same AFC value and different AMH level showed that the higher AMH level group(group 1 vs.group 4,group 2 vs.group 5,group 5 vs.group 8,group 6 vs.group 9)had significantly higher oocytes retrieval rate and transplantable embryo rate(P<0.05).In comparison among the groups with inconsistent level of AMH and AFC,the group with higher serum AMH level had significantly more numbers of oocytes retrieved and transplantable embryos than the group with higher AFC(group 2 vs.group 4)in the patients with low ovarian reserve function.However,the patients in the group with higher AFC had higher number of oocytes retrieved and transplantable embryos than the group with higher serum AMH level(group 6 vs.group 8)in the patients with high ovarian reserve function(P<0.05).Conclusions:When AMH and AFC is inconsistent,the ovarian response is between the high and low ovarian responses when they are consistent.AMH level has more predictive value when ovarian reserve function is low,and AFC has more predictive value when ovarian reserve function is high.

关 键 词：窦卵泡计数 抗苗勒管激素 卵巢反应 获卵数 

分 类 号：R711.6[医药卫生—妇产科学]