OBJECTIVE

目 的

Anti-mullerian hormone (AMH) is a reliable predictor of ovarian response in IVF. However, its role as a prognostic marker of pregnancy outcome is conflicting. While high AMH corresponds to improved oocyte yield, AMH serum concentration of 5 ng/mL was associated with decreased odds of life birth following fresh transfer . The outcome following frozen embryo transfer (FET) remains unexplored. Therefore, the objective if this study was to evaluate the association between high AMH and live birth in autologous IVF cycle followed by at least one FET.

抗苗勒氏管激素（AMH）是体外受精（IVF）中卵巢反应的可靠预测指标。然而，它作为妊娠结果的预测标志物的角色存在争议。尽管高AMH与获卵数增多相关，但血清AMH为5 ng/mL时与新鲜移植后活产率降低相关。冷冻胚胎移植（FET）后的结果尚未探讨。因此，本研究的目的是评估高AMH与自体IVF周期中的活产之间的关联，且随后至少进行一个FET周期后活产之间的关系。

MATERIALS AND METHODS

材料与方法

Retrospective analysis of the Shady Grove database from January 2010 to December 2020. All fresh autologous IVF cycles with available AMH value performed in last 6 months before IVF (n=29,434), were included. Based on AMH serum concentration, cycles were stratified into 3 groups; Low (<1 ng/mL), intermediate (1.0-4.9 ng/mL), and high (≥5 ng/mL). Cycle characteristics were compared compared between the individual groups using 3-way ANOVA. Pregnancy outcomes such as live birth rate (LBR), and miscarriage rates were compared using chi-squared test.

对Shady Grove数据库进行回顾性分析，时间跨度为2010年1月至2020年12月。纳入了在IVF前6个月内进行的所有新鲜自体IVF周期，并且有可用的AMH值（n=29,434）。根据血清AMH水平，将周期分为3组，低水平组（＜1ng/ml）、中等水平组（1.0-4.9ng/ml）和高水平组（≥5ng/ml）。采用三元方差分析比较各组间的周期特征。采用卡方检验比较妊娠结局，如活产率（LBR）、流产率。

RESULTS

结 果

Women in the high AMH group were younger (33.1± 4.1) and had higher antral follicle count (26.5±5.3) than the intermediate and low AMH groups (<0.001). High AMH patients required lower gonadotropin dose (2323.9±1117.2 IU) than other groups (p<0.001) however average stimulation day was 12 in all groups. In the high AMH group, 32.6% of patients had PCOS. The number of mature oocytes was significantly higher in the high AMH group as compared to intermediate and low AMH groups (17 vs.10 vs. 4, p< 0.001). Following fresh embryo transfer, LBR was significantly higher in the high AMH group (46%) as compared to intermediate AMH (40.4%) and low AMH (27%); p < 0.01.

When FET cycle outcomes were compared, LBR was significantly higher in the high (46.7%) and intermediate (47.4%) AMH group as compared to low AMH group (43.7%), p< 0.001. There was no difference in LBR between the high and intermediate group (p=0.365). There was no difference noted in miscarriage rate between low (12.3%), intermediate (12.1%) and high (12.4%) AMH group (p=0.807).

高水平AMH组的患者更年轻（33.1±4.1），且窦卵泡计数（26.5±5.3）也高于中等水平AMH组和低水平AMH组（＜0.001）。与其他两组相比，高水平AMH组患者需要促性腺激素的剂量更低（2323.9±1117.2），但所有组的平均刺激日均为12天。在高水平AMH组中，有32.6%的患者患有多囊卵巢综合征（PCOS）。高水平AMH组的成熟卵母细胞数量明显高于中、低水平AMH组（17 vs 10 vs 4，p＜0.001）。新鲜胚胎移植后，高水平AMH组活产率（46%）明显高于中等水平AMH组（40.4%）和低水平AMH组（27%），P＜0.01。

然而，比较FET周期结果发现，高水平AMH组（46.7%）和中等水平AMH组（47.4%）的活产率显著高于低水平AMH组（43.7%），p＜0.001。高水平AMH组和中等水平AMH组间活产率无差异（p=0.365）。低水平AMH组（12.3%）、中等水平AMH组（12.1%）、高水平AMH组（12.4%）的流产率无差异（p=0.807）。

CONCLUSIONS

结 论

High serum AMH levels 5 ng/mL are not associated with lower LBR per transfer either following fresh or frozen embryo transfer.

无论是新鲜胚胎移植还是冷冻胚胎移植后，高血清水平AMH （5ng/ml）与每次移植后的低活产率无关。

IMPACT STATEMENT

影响陈述

This finding is reassuring to suggest that high AMH values do not predict lower success from ART and do not affect the intrinsic quality of oocytes/ embryos.

这一发现是令人欣慰的，其表明高AMH值并不预示着辅助生殖技术的成功率较低，也不影响卵母细胞或胚胎的内在质量。

文章来源：

EFFECTS OF INCREASING ANTIMULLERIAN HORMONE LEVEL ON IN-VITRO FERTILIZATION AND FROZEN EMBRYO TRANSFER OUTCOMES Sarkar, Papri et al.Fertility and Sterility, Volume 120, Issue 4, e303