低水平抗苗勒管激素患者体外受精妊娠失败的影响因素分析  

The Analysis of Influencing Factors of Pregnancy Failure of IVF/ICSI in Patients with Low Serum AMH Level

作　　者：刘兰 张莹[1] 曾艳如 曹祺 唐恬 LIU Lan;ZHANG Ying;ZENG Yanru(Department of Reproductive Medicine,West China Second Hospital,Sichuan University,Key Laboratory of Birth Defects and Related Diseases of Women and Children,Ministry of Education,Chengdu Sichuan 610041,China;West China Clinical Medical College,Sichuan University,Chengdu Sichuan 610041,China)

机构地区：[1]四川大学华西第二医院生殖医学科出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041 [2]四川大学华西临床医学院,四川成都610041

出　　处：《实用妇产科杂志》2024年第11期933-939,共7页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨低水平抗苗勒管激素(AMH)患者在体外受精/卵胞浆内单精子注射(IVF/ICSI)中妊娠失败的影响因素。方法:回顾性分析于2020年1月1日至2020年12月31日在四川大学华西第二医院生殖医学科接受IVF/ICSI治疗的931例(1184个周期)血清AMH<1.1 ng/ml患者的临床资料。其中503例(525个周期)患者进行了胚胎移植,临床妊娠组193例(193个周期)和临床未妊娠组310例(332个周期);对所有患者根据年龄<35岁、35~<40岁、40~51岁分组,AMH水平<0.06 ng/ml、0.06~<0.20 ng/ml、0.20~<0.50 ng/ml、0.50~<0.80 ng/ml、0.80~<1.10 ng/ml分组,分析年龄、AMH与妊娠结局的关系,采用多因素Logistic回归分析影响低水平AMH患者IVF/ICSI后妊娠失败的相关因素。结果:①与临床妊娠组相比,临床未妊娠组患者的年龄更大,AMH水平和窦卵泡数(AFC)更低,成熟卵母细胞(MⅡ)数、双原核(2PN)受精数、可利用胚胎数、优质胚胎数更少,取卵时子宫内膜厚度更薄,差异有统计学意义(P<0.05)。②不同年龄组间的AMH水平、AFC数、体质量指数(BMI)、促性腺激素(Gn)总量、MⅡ数比较,差异有统计学意义(P<0.05);每移植周期临床妊娠率、每取卵周期临床妊娠率、每促排卵周期临床妊娠率差异也有统计学意义(P<0.001)。③低水平AMH不同范围间的每移植周期临床妊娠率、每取卵周期临床妊娠率和每促排卵周期临床妊娠率的差异有统计学意义(P<0.05)。④多因素Logistic回归分析示,年龄是影响低水平AMH患者胚胎移植后妊娠结局的主要因素(P=0.002)。ROC曲线示,预测临床妊娠的年龄最佳截断值为35.5岁,曲线下面积为0.634(95%CI 0.586~0.682,P<0.001)。结论:对于低水平AMH(<1.1 ng/ml)的患者在IVF/ICSI治疗后仍有妊娠的机会,年龄是影响临床妊娠率的主要因素,而不是AMH的微小差异。患者实际年龄低于35.5岁时,即使AMH水平较低也可能有较好的胚胎移植后临床妊娠结局。Objective:The study aimed to investigate the factors of pregnancy failures in patients with low serum anti-Müllerian hormone(AMH)level after in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI).Method:The clinical outcome of 1184 cycles in 931 patients with serum AMH<1.1 ng/ml undergoing IVF/ICSI at the Department of Reproductive Medicine of West China Second Hospital,Sichuan University between January 1,2020 and December 31,2020,was retrospectively studied.In total,503 patients(525 cycles)underwent embryo transfer,including clinical pregnant group in 193 patients(193 cycles)and clinical non-pregnant group in 310 patients(332 cycles).All of the patients were divided into three different groups according to their chronological age(<35,35-<40,40-51 years old)and five different serum AMH levels(<0.06 ng/ml,0.06-<0.20 ng/ml,0.20-<0.50 ng/ml,0.50-<0.80 ng/ml,0.80-<1.10 ng/ml),to explore the relationship with IVF pregnancy outcomes.Multivariate Logistic regression analysis was carried out to explore factors affecting pregnancy outcomes afer IVF/ICSI.Results:①Compared with the clinical pregnancy group,the clinical non-pregnant patients were older,AMH level and antral follicle count(AFC)were lower,the number of MII,2PN,available embryos and top quality embryos were also lower,and endometrial thickness at oocyte pickup(OPU)was thinner,and differences above were statistically significant(P<0.05).②AMH level,AFC,BMI,total Gn and MII number were significantly different among different age groups(P<0.05).The clinical pregnancy rate per transplantation cycle,per oocyte pickup cycle and per ovulation induction cycle also had statistically significant differences(P<0.001),and the pregnancy rate showed a decreasing trend with the increase of age.③There were significant differences in clinical pregnancy rate per transplantation cycle,per oocyte pickup cycle and per ovulation induction cycle among different ranges of low level AMH(P<0.05).④Multivariable Logistic regression analysis confirmed that the probabi

关 键 词：抗苗勒管激素 体外受精 胚胎移植 妊娠结局 年龄 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]