Dynamic antimullerian hormone levels during controlled ovarian hyperstimulation predict in vitro fertilization response and pregnancy outcomes
Dynamic antimullerian hormone levels during controlled ovarian hyperstimulation predict in vitro fertilization response and pregnancy outcomes
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DOI：
10.1016/j.fertnstert.2015.07.1161
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发表时间：
2015-11-01
影响因子：
6.7
通讯作者：
Toth, Thomas L.
中科院分区：
文献类型：
--
作者：
Styer, Aaron K.;Gaskins, Audrey J.;Toth, Thomas L.
目的：探讨控制性卵巢过度刺激（COH）期间血清抗苗勒管激素（AMH）的变化规律及其与并发反应和体外受精（IVF）妊娠结局的关系。设计：前瞻性队列研究。环境：学术医疗中心。患者：2012年9月1日至2013年1月1日共113例连续新鲜IVF胚胎移植周期。干预措施：COH期间每天进行连续血清AMH测量分析，同时抽取血清雌二醇（E-2）。主要结局指标：COH - AMH变化率[δ ng/mL / day]（分层）与卵巢反应和妊娠结局之间的关系。结果：COH期间，AMH下降。年龄和卵巢储备检测与AMH下降率（RAD）相关。与RAD最严重的女性相比，中度和轻度RAD的女性卵泡>= 12 mm更少，血清E-2峰值更低，卵母细胞更少，早期胚胎发育更差。与RAD最严重的患者相比，RAD最严重的患者（校正优势比3.51；95%可信区间1.03,11.94）和年龄大于35岁的患者(校正优势比6.95；95%置信区间，1.09,44.1)。结论：COH AMH下降率与卵巢储备测试、卵母细胞产量、胚胎发育和临床妊娠率有关，特别是在35岁以上的女性中。这些结果表明，动态AMH水平可能提供一种新的周期内方法来预测体外受精后的反应和治疗结果。(C) 2015年美国生殖医学学会。
Objective: To evaluate the patterns of change in serum antimullerian hormone (AMH) during controlled ovarian hyperstimulation (COH) and their relation to concurrent response and in vitro fertilization (IVF) pregnancy outcomes.Design: Prospective cohort study.Setting: Academic medical center.Patient(s): A total of 113 consecutive fresh IVF embryo transfer cycles from September 1, 2012 through January 1, 2013.Intervention(s): Serial serum AMH measurements were analyzed on each day that serum estradiol (E-2) was drawn during COH.Main Outcome Measure(s): Relationship between the rate of COH AMH change [Delta ng/mL per day] (stratified into tertiles), and ovarian response, and pregnancy outcomes.Result(s): During COH, AMH declined. Age and ovarian reserve testing were associated with the rate of AMH decline (RAD). Women with intermediate and minimal RAD had statistically significantly fewer follicles >= 12 mm, lower peak serum E-2, fewer oocytes, and inferior early embryo development compared with women with the greatest RAD. Compared with patients with the lowest RAD, clinical pregnancy was more likely in patients with the greatest RAD in the total population (adjusted odds ratio 3.51; 95% confidence interval, 1.03, 11.94) and among patients older than 35 years (adjusted odds ratio 6.95; 95% confidence interval, 1.09, 44.1).Conclusion(s): The rate of COH AMH decline was associated with ovarian reserve testing, oocyte yield, embryo progression, and clinical pregnancy rates, particularly in women older than 35 years. These results suggest that dynamic AMH levels may provide a novel intracycle approach to predict response and treatment outcomes after IVF. (C) 2015 by American Society for Reproductive Medicine.