抗米勒管激素联合获卵数对大龄女性新鲜周期体外受精-胚胎移植临床妊娠结局的预测价值  

Predictive value of anti-Müllerian hormone combined with number of retrieved oocytes for clinical pregnancy outcomes of fresh cycle of in vitro fertilization and embryo transfer in older women

作　　者：王晓芳 徐进 张翠莲 WANG Xiaofang;XU Jin;ZHANG Cuilian(Center for Reproductive Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院生殖中心郑州大学人民医院,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2024年第11期1117-1121,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200037)。

摘　　要：目的观察行新鲜周期体外受精-胚胎移植(IVF-ET)助孕的大龄(年龄≥35岁)女性基础抗米勒管激素(AMH)、获卵数对临床妊娠结局的影响,探讨二者对临床妊娠结局的预测价值。方法2017年1月—2020年3月河南省人民医院行新鲜周期IVF-ET助孕的大龄女性659例,均采用标准长效长方案促排卵,常规体外受精,新鲜周期单卵裂期胚胎移植。根据临床妊娠情况将659例患者分为妊娠组311例,未妊娠组348例。比较2组年龄,体质量指数,不孕年限,基础卵泡刺激素、黄体生成素、雌二醇、AMH、窦卵泡数,获卵数,成熟卵子数,囊胚形成数,正常卵裂数,可利用胚胎数,优良胚胎数;Spearman相关法分析基础AMH、获卵数与临床妊娠率的相关性;多因素logistic回归分析行新鲜周期IVF-ET助孕的大龄女性临床妊娠结局的影响因素;绘制ROC曲线,评估基础AMH、获卵数预测行新鲜周期IVF-ET助孕大龄临床妊娠结局的效能。结果(1)未妊娠组年龄[(38.64±3.01)岁]大于妊娠组[(37.42±2.41)岁](t=5.722,P<0.001),基础AMH[(2.38±2.14)μg/L]、基础窦卵泡数[(8.74±4.47)个]、获卵数[(6.55±3.79)个]、成熟卵子数[(5.41±3.56)个]、可利用胚胎数[(2.93±2.12)个]、囊胚形成数[0(0,0.25)个]均少于妊娠组[(2.82±2.37)μg/L、(9.72±5.13)个、(7.69±3.96)个、(6.26±3.79)个、(3.53±2.29)个、0(0,2.00)个](t=2.478~3.782,U=3.584,P均<0.05),体质量指数、不孕年限、基础卵泡刺激素、基础黄体生成素、基础雌二醇、正常卵裂数、优良胚胎数与妊娠组比较差异无统计学意义(P>0.05)。(2)基础AMH、获卵数均与临床妊娠率呈正相关(r=0.121,P=0.002;r=0.162,P<0.001)。(3)年龄(OR=1.147,95%CI:1.075~1.223,P<0.001)、基础AMH(OR=0.480,95%CI:0.321~0.717,P<0.001)、获卵数(OR=0.483,95%CI:0.336~0.693,P<0.001)是行新鲜周期IVF-ET助孕大龄女性临床妊娠结局的影响因素。(4)基础AMH、获卵数分别以1.925μg/L、5.5个为最佳截断值,预测行新鲜周期Objective To observe the influences of basic anti-Müllerian hormone(AMH)and number of retrieved oocytes on the clinical pregnancy outcome in older women aged≥35 years old receiving fresh-cycle in vitro fertilization and embryo transfer(IVF-ET),and to investigate the value of combination of basic AMH and number of retrieved oocytes to the prediction of clinical pregnancy outcome.Methods A total of 659 older women underwent fresh-cycle IVF-ET for assisted pregnancy in Henan Provincial People's Hospital from January 2017 to March 2020,All patielts received standard long-acting regimen for ovulation induction,routine in vitro fertilization.and fresh-cycle single cleavage stage embryos transfer,According to the clinical pregnancy result,659 patients were divided into pregnant group(n=311)and no-pregnant group(n=348).The age,body mass index,infertility years,basic follicle stimulating hormone,luteinizing hormone,estradiol,AMH,number of antral follicles,number of retrieved oocytes,number of mature eggs,number of blastocysts,number of normal cleavages,number of available embryos,and number of high quality embryos were compared between two groups.Spearman correlation analysis was done to assess the correlations of basic AMH and number of retrieved oocytes with the clinical pregnancy outcome.Multivariate logistic regression analysis was done to analyze the influencing factors of clinical pregnancy outcomes in older women receiving fresh-cycle IVF-ET.ROC curves were plotted to evaluate the efficiencies of basic AMH and number of retrieved oocytes on predicting the clinical pregnancy outcome.Results(1)The age was significantly older in no-pregnant group[(38.64±3.01)years]than that in pregnant group[(37.42±2.41)years](t=5.722,P<0001).The basic AMH,number of basic antral follicles,number of retrieved oocytes,number of mature eggs,number of available embryos,and number of blastocysts were less in no-pregnant group[(2.38±2.14)ug/L,8.74±4.47,6.55±3.79,5.41±3.56,2.93±2.12,0(0,0.25)]than those in pregnant group[(2.82±2.3

关 键 词：体外受精-胚胎移植 新鲜周期 抗米勒管激素 获卵数 临床妊娠结局 预测价值 

分 类 号：R714.8[医药卫生—妇产科学]