Anti-mullerian Hormone for the Prediction of Ovarian Response in Progestin-Primed Ovarian Stimulation Protocol for IVF
Anti-mullerian Hormone for the Prediction of Ovarian Response in Progestin-Primed Ovarian Stimulation Protocol for IVF
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抗苗勒氏管激素用于预测 IVF 孕激素卵巢刺激方案中卵巢反应
DOI：
10.3389/fendo.2019.00325
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发表时间：
2019-05-28
影响因子：
5.2
通讯作者：
Kuang, Yanping
中科院分区：
文献类型：
--
作者：
Huang, Jialyu;Lin, Jiaying;Kuang, Yanping
背景：抗苗勒管激素（AMH）在促性腺激素释放激素激动剂和拮抗剂治疗中预测卵巢反应的能力已被广泛研究，但关于其在孕激素刺激卵巢（PPOS）方案中的价值尚无信息。方法：回顾性分析2015年1月至2018年7月在我中心采用PPOS方案进行第一次体外受精/胞浆内单精子注射周期的523例无多囊卵巢综合征患者的资料。在卵巢刺激前12个月内使用自动Access AMH测定获得血清AMH测量值。结果：AMH与取卵数呈正相关（r = 0.744, P < 0.001）。对于不良反应（15个卵母细胞）的预测，AMH的受试者工作特征曲线下面积（AUC）分别为0.861和0.773，对应的最佳截断点分别为1.26和4.34 ng/mL。当根据醋酸甲羟孕酮（MPA）剂量（4 mg vs. 10 mg / d）分层时，AMH对两组不良反应（AUC分别为0.829和0.886）和高反应（AUC分别为0.770和0.814）的预测价值相似。在314名接受PPOS方案首次冷冻胚胎移植（FET）的妇女中，在AMH四分位数（4.35 ng/mL）中，生化妊娠、临床妊娠、着床、早期流产、多胎妊娠和异位妊娠的发生率无显著差异（P < 0.05）。在多变量logistic回归模型中，年龄是临床妊娠的唯一独立危险因素（P = 0.011）。结论：我们的数据表明，无论MPA剂量如何，AMH都能充分预测PPOS方案中卵巢反应的高低，但在冻结所有策略的第一个FET周期中，AMH与妊娠结局无关。
Background: The ability of anti-Mullerian hormone (AMH) to predict ovarian response has been studied extensively in gonadotropin-releasing hormone agonist and antagonist treatments, but no information is available regarding its value in progestin-primed ovarian stimulation (PPOS) protocol.Methods: This retrospective data analysis included 523 patients without polycystic ovary syndrome who underwent their first in vitro fertilization/intracytoplasmic sperm injection cycle with PPOS protocol at our center between Jan. 2015 and Jul. 2018. Serum AMH measurements were acquired within 12 months prior to ovarian stimulation using the automated Access AMH assay.Results: AMH exhibited a significantly positive correlation with the number of retrieved oocytes (r = 0.744, P < 0.001). For the prediction of poor (15 oocytes) response, AMH had an area under the receiver operating characteristic curve (AUC) of 0.861 and 0.773, corresponding with an optimal cutoff point of 1.26 and 4.34 ng/mL, respectively. When stratified according to the dose of medroxyprogesterone acetate (MPA) (4 mg vs. 10 mg per day), AMH retained its similarly high predictive value for poor (AUC = 0.829 and 0.886, respectively) and high response (AUC = 0.770 and 0.814, respectively) in both groups. Amongst the 314 women who received their first frozen embryo transfer (FET) following PPOS protocol, no significant differences were observed on the rates of biochemical pregnancy, clinical pregnancy, implantation, early miscarriage, multiple pregnancy and ectopic pregnancy (all P > 0.05) across AMH quartiles (4.35 ng/mL). In a multivariable logistic regression model, age was suggested to be the only independent risk factor for clinical pregnancy (P = 0.011).Conclusions: Our data demonstrated that AMH is an adequate predictor of both high and poor ovarian response in PPOS protocol regardless of MPA dose, but it does not associate with pregnancy outcomes in the first FET cycles in a freeze-all strategy.