Evaluation of anti-Mullerian hormone as a test for the prediction of ovarian reserve
Evaluation of anti-Mullerian hormone as a test for the prediction of ovarian reserve
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DOI：
10.1016/j.fertnstert.2007.07.1293
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发表时间：
2008-09-01
影响因子：
6.7
通讯作者：
Lambalk, Cornelis
中科院分区：
文献类型：
--
作者：
Kwee, Janet;Schats, Roel;Lambalk, Cornelis
目的：综合比较基础血清抗苗勒管激素（AMH）水平与大多数已建立的卵巢储备试验的价值。设计：前瞻性随机对照试验。地点：荷兰一所大学医院的生育中心。患者：110名接受第一次试管婴儿周期的患者，通过计算机设计的四组系统随机分为两组。干预：56例患者进行了克罗米芬柠檬酸激发试验（CCCT）， 54例患者进行了外源性FSH卵巢储备试验（EFORT）。所有患者均测量基础AMH、基础FSH、基础抑制素B、窦卵泡计数（AFC）和卵巢基础体积。在所有患者中，测试之后都进行了标准的体外受精治疗。主要结局指标：IVF治疗中卵巢过度刺激后的卵巢反应，以受刺激的卵泡总数、回收的卵母细胞总数和持续妊娠数表示。结果：同时考虑AFC、EFORT中抑制素B的增加和卵巢基础体积的多元回归预测模型对卵巢储备(Y)的预测效果最好。单因素logistic回归显示，不良反应的最佳预测因子是AMH、CCCT基础FSH和AFC。对于高反应，单变量逻辑回归显示AFC是最佳预测因子。多元逻辑回归分析在改善不良反应或高反应的预测方面没有产生更好的模型。预测非妊娠的最佳预测因子是CCCT和EFORT中的E-2增量。结论：抗苗勒管激素可与其他常用的卵巢储备试验相媲美，但可能是最适用于一般实践的。
Objective: To compare in an integral way the value of the basal serum anti-Mullerian hormone (AMH) level with most of the established ovarian reserve tests.Design: Prospective randomized controlled trial.Setting: Fertility center of a university hospital in the Netherlands.Patient(s): One hundred ten patients undergoing their first IVF cycle who were randomized, by a computer-designed four-block system, into two groups.Intervention(s): Fifty-six patients underwent a clomiphene citrate challenge test (CCCT), and 54 patients underwent an exogenous FSH ovarian reserve test (EFORT). In all patients, basal AMH, basal FSH, basal inhibin B, antral follicle count (AFC), and basal volume of the ovaries were measured. In all patients, the test was followed by a standard IVF treatment.Main Outcome Measure(s): Ovarian response after ovarian hyperstimulation in an IVF treatment, expressed as the total number of stimulated follicles, retrieved oocytes, and ongoing pregnancies.Result(s): The best prediction of ovarian reserve (Y) was seen in a multiple regression prediction model that simultaneously included AFC, inhibin B increment in the EFORT, and basal volume of the ovaries. Univariate logistic regression showed that the best predictors for poor response were AMH, the CCCT basal FSH, and the AFC. For hyperresponse, univariate logistic regression showed that the best predictor was AFC. Multiple logistic regression analysis did not produce a better model in terms of improving the prediction of poor response or hyperresponse. The best predictors for the prediction of non-pregnancy were the CCCT and the E-2 increment in the EFORT.Conclusion(s): Anti-Mullerian hormone is comparable with other commonly used ovarian reserve tests but is probably most applicable in general practice.