不同年龄段血清抗苗勒管激素水平(AMH)与试管婴儿临床妊娠率的相关性及临床预测价值
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摘要
目的临床检测不同年龄段接受体外受精-胚胎移植(IVF-ET)的不孕患者的血清抗苗勒管激素水平(AMH),分析讨论不同年龄者AMH与试管婴儿临床妊娠率的相关性及其对妊娠结局的预测价值。方法选取2015年10月～2017年12月在我院初次接受IVF-ET的143例不孕患者作为主要研究对象。按年龄大小分为A组42例(<30岁),B组45例(30～35岁),C组43例(36～39岁),D组13例(≥40岁)。采用酶联吸附法检测4组患者血清AMH水平,记录患者窦卵泡数、获卵数,妊娠率等相关参数,分析各组血清AMH水平与妊娠率的相关性,及其对临床妊娠的预测价值。结果 4组AMH水平及Gn总量间差异均有统计学意义(P<0.05),且AMH水平随着年龄增加而降低,其中D组的AMH水平最低为(1.75±0.87)ng/ml,明显低于A组的(3.84±1.66)ng/ml及B组的(3.42±1.29)ng/ml,差异有统计学意义(P<0.05);Gn总量随年龄增加而升高,其中D组的Gn总量最高为(39.54±9.46)75单位/安瓿,明显高于A组的(28.65±7.64)75单位/安瓿、B组的(32.39±9.54)75单位/安瓿,差异有统计学意义(P<0.05);4组临床妊娠率间差异均有统计学意义(P<0.05),且临床妊娠率随着年龄增加而降低,其中D组的妊娠率最低为23.08%,明显低于A组的73.81%、B组的60.00%及C组的48.84%,差异有统计学意义(P<0.05);Pearson结果显示:AMH水平与临床妊娠率存在明显正相关(r=0.541,P<0.001)。结论 AMH水平虽与妊娠率呈正相关,但无法作为预测试管婴儿妊娠结局的独立指标,临床应综合考虑患者AMH水平与年龄,以为提高试管婴儿成功率提供更多指导建议。
Objective:To detect the serum anti-Mullerian hormone levels(AMH)of infertile patients undergoing in vitro fertilization-embryo transfer(IVF-ET)in different age groups,and to analyze the relationship between AMH and IVF clinical pregnancy rate in different age groups.Sex and its predictive value for pregnancy outcomes.Methods:A total of 143 infertile patients who received IVF-ET for the first time in our hospital from October 2015 to December 2017 were selected as the main subjects.According to age,42 patients(<30 years old)in group A,45 patients(30-35 years old)in group B,43 patients(36-39 years old)in group C,and 13 patients(≥40 years old)in group D.The serum AMH levels of the four groups were detected by enzyme-linked immunosorbent assay.The number of antral follicles,the number of eggs obtained,the pregnancy rate and other related parameters were recorded.The correlation between serum AMH levels and pregnancy rate and the predictive value of clinical pregnancy were analyzed.Results:There were significant differences in the AMH levels and Gn totals between the four groups(P<0.05),and the AMH levels decreased with age.The lowest AMH level in group D was(1.75±0.87)ng/ml.Significantly lower than(3.84±1.66)ng/ml in group A and(3.42±1.29)ng/ml in group B,the difference was statistically significant(P<0.05);the total amount of Gn increased with age,of which D The total amount of Gn in the group was(39.54±9.46)75 units/amperes,which was significantly higher than that in group A(28.65±7.64)75 units/amperes,and in group B(32.39±9.54)75 units/ampoules.The difference was statistically significant.Significance(P<0.05);the difference of clinical pregnancy rate between the four groups was statistically significant(P<0.05),and the clinical pregnancy rate decreased with age,and the pregnancy rate of group D was 23.08%,which was significantly lower than that.73.81% in group A,60.00% in group B and 48.84% in group C,the difference was statistically significant(P<0.05);Pearson results showed that there was a significant positive correlation between AMH level and clinical pregnancy rate(r=0.541,P<0.001).Conclusion:Although the AMH level is positively correlated with the pregnancy rate,it can not be used as an independent index to predict the pregnancy outcome of IVF.The clinical AMH level and age should be considered comprehensively,so as to provide more guidance for improving the success rate of IVF.
Objective:To detect the serum anti-Mullerian hormone levels(AMH)of infertile patients undergoing in vitro fertilization-embryo transfer(IVF-ET)in different age groups,and to analyze the relationship between AMH and IVF clinical pregnancy rate in different age groups.Sex and its predictive value for pregnancy outcomes.Methods:A total of 143 infertile patients who received IVF-ET for the first time in our hospital from October 2015 to December 2017 were selected as the main subjects.According to age,42 patients(<30 years old)in group A,45 patients(30-35 years old)in group B,43 patients(36-39 years old)in group C,and 13 patients(≥40 years old)in group D.The serum AMH levels of the four groups were detected by enzyme-linked immunosorbent assay.The number of antral follicles,the number of eggs obtained,the pregnancy rate and other related parameters were recorded.The correlation between serum AMH levels and pregnancy rate and the predictive value of clinical pregnancy were analyzed.Results:There were significant differences in the AMH levels and Gn totals between the four groups(P<0.05),and the AMH levels decreased with age.The lowest AMH level in group D was(1.75±0.87)ng/ml.Significantly lower than(3.84±1.66)ng/ml in group A and(3.42±1.29)ng/ml in group B,the difference was statistically significant(P<0.05);the total amount of Gn increased with age,of which D The total amount of Gn in the group was(39.54±9.46)75 units/amperes,which was significantly higher than that in group A(28.65±7.64)75 units/amperes,and in group B(32.39±9.54)75 units/ampoules.The difference was statistically significant.Significance(P<0.05);the difference of clinical pregnancy rate between the four groups was statistically significant(P<0.05),and the clinical pregnancy rate decreased with age,and the pregnancy rate of group D was 23.08%,which was significantly lower than that.73.81% in group A,60.00% in group B and 48.84% in group C,the difference was statistically significant(P<0.05);Pearson results showed that there was a significant positive correlation between AMH level and clinical pregnancy rate(r=0.541,P<0.001).Conclusion:Although the AMH level is positively correlated with the pregnancy rate,it can not be used as an independent index to predict the pregnancy outcome of IVF.The clinical AMH level and age should be considered comprehensively,so as to provide more guidance for improving the success rate of IVF.
引文
[1]张盼盼,董莉.改善体外受精-胚胎移植患者卵泡及子宫内膜容受性作用机制的研究进展[J].中国综合临床,2017,33(1):75-77.
[2]彭蓉,刘丽群,潘伟,等.子宫内膜形态与体外受精-胚胎移植妊娠的相关性分析[J].中国性科学,2017,26(10):131-134.
[3]叶虹.血清抗苗勒管激素检测在IVF中的意义[J].生殖医学杂志,2015,24(1):1-4.
[4]Kimura A P,Yoneda R,Kurihara M,et al.A Long Noncoding RNA,lncRNA-Amhr2,Plays a Role in Amhr2 Gene Activation in Mouse Ovarian Granulosa Cells.[J].Endocrinology,2017,158(11):4105-4121.
[5]欧阳小娥,胡蓉.AMH对辅助生殖妊娠结局预测价值的Meta分析[J].国际生殖健康/计划生育杂志,2017,36(4):269-275.
[6]Jamil Z,Fatima S S,Rehman R,et al.Anti Mullerian Hormone:Ovarian response indicator in young patients receiving Long GnRHAgonist Protocol for Ovarian Stimulation[J].Pak J Med Sci,2016,32(4):944-949.
[7]姚秋萍,方春霞,王丽萍,等.抗苗勒氏管激素预测体外受精中卵巢反应性的研究[J].中国妇幼保健,2017,32(23):5965-5966.
[8]张洪,陆丽芳,梁珊.生育期女性血清抗苗勒管激素与年龄及性激素水平的相关性分析[J].中国计划生育学杂志,2018,26(5):386-369.
[9]张秀萍,龙志晶.抗苗勒管激素及窦卵泡数对卵巢储备功能的预测评价[J].中国优生与遗传杂志,2015,23(7):116-117.
[10]Crawford S,Smith R A,Kuwabara S A,et al.Risks Factors and Treatment Use Related to Infertility and Impaired Fecundity Among Reproductive-Aged Women[J].J Womens Health,2017,26(5)500-510.
[11]张玲,邸玥莹,梅俊,等.血清抗苗勒管激素检测40岁以上不孕患者IVF中临床意义的探讨[J].中国优生与遗传杂志,2016,24(11):105-106.
[12]Aboulghar M,Saber W,Amin Y,et al.Impact of antimüllerian hormone assays on the outcomes of in vitro fertilization:a prospective controlled study[J].Fertil Steril,2014,101(1):134-137.
[13]陈艺,刘海鹏,李苏萍,等.抗苗勒氏管激素水平对IVF-ET妊娠结局的预测价值评估[J].生殖医学杂志,2016,25(6):522-527.
[14]滕依丽,林文琴,赵军招,等.年龄及基础卵泡刺激素与卵巢反应性及IVF-ET治疗结局的相关研究[J].实用医学杂志,2011,27(22):4091-4093.
[15]余照娟,郭培培,黄苗苗,等.不同年龄段患者基础FSH/LH比值对IVF/ICSI-ET临床结局的预测价值[J].安徽医科大学学报,2017,52(2):269-272.
[16]Cahill D J,Wardle P G.Age and basal follicle stimulating hormone as predictors in in vitro fertilisation outcome[J].Bj J Obstet Gynaecol,2010,105(1):107-112.
[2]彭蓉,刘丽群,潘伟,等.子宫内膜形态与体外受精-胚胎移植妊娠的相关性分析[J].中国性科学,2017,26(10):131-134.
[3]叶虹.血清抗苗勒管激素检测在IVF中的意义[J].生殖医学杂志,2015,24(1):1-4.
[4]Kimura A P,Yoneda R,Kurihara M,et al.A Long Noncoding RNA,lncRNA-Amhr2,Plays a Role in Amhr2 Gene Activation in Mouse Ovarian Granulosa Cells.[J].Endocrinology,2017,158(11):4105-4121.
[5]欧阳小娥,胡蓉.AMH对辅助生殖妊娠结局预测价值的Meta分析[J].国际生殖健康/计划生育杂志,2017,36(4):269-275.
[6]Jamil Z,Fatima S S,Rehman R,et al.Anti Mullerian Hormone:Ovarian response indicator in young patients receiving Long GnRHAgonist Protocol for Ovarian Stimulation[J].Pak J Med Sci,2016,32(4):944-949.
[7]姚秋萍,方春霞,王丽萍,等.抗苗勒氏管激素预测体外受精中卵巢反应性的研究[J].中国妇幼保健,2017,32(23):5965-5966.
[8]张洪,陆丽芳,梁珊.生育期女性血清抗苗勒管激素与年龄及性激素水平的相关性分析[J].中国计划生育学杂志,2018,26(5):386-369.
[9]张秀萍,龙志晶.抗苗勒管激素及窦卵泡数对卵巢储备功能的预测评价[J].中国优生与遗传杂志,2015,23(7):116-117.
[10]Crawford S,Smith R A,Kuwabara S A,et al.Risks Factors and Treatment Use Related to Infertility and Impaired Fecundity Among Reproductive-Aged Women[J].J Womens Health,2017,26(5)500-510.
[11]张玲,邸玥莹,梅俊,等.血清抗苗勒管激素检测40岁以上不孕患者IVF中临床意义的探讨[J].中国优生与遗传杂志,2016,24(11):105-106.
[12]Aboulghar M,Saber W,Amin Y,et al.Impact of antimüllerian hormone assays on the outcomes of in vitro fertilization:a prospective controlled study[J].Fertil Steril,2014,101(1):134-137.
[13]陈艺,刘海鹏,李苏萍,等.抗苗勒氏管激素水平对IVF-ET妊娠结局的预测价值评估[J].生殖医学杂志,2016,25(6):522-527.
[14]滕依丽,林文琴,赵军招,等.年龄及基础卵泡刺激素与卵巢反应性及IVF-ET治疗结局的相关研究[J].实用医学杂志,2011,27(22):4091-4093.
[15]余照娟,郭培培,黄苗苗,等.不同年龄段患者基础FSH/LH比值对IVF/ICSI-ET临床结局的预测价值[J].安徽医科大学学报,2017,52(2):269-272.
[16]Cahill D J,Wardle P G.Age and basal follicle stimulating hormone as predictors in in vitro fertilisation outcome[J].Bj J Obstet Gynaecol,2010,105(1):107-112.
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