Objective: Explore the value of anti-Müllerian hormone (AMH) in predicting pregnant outcomes of polycystic ovary syndrome (PCOS) patients undergone assisted reproductive technology. Methods: The study totally recruited 1 697 patients who underwent the first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycle in Sun Yat-sen Memorial Hospital from the January 2014 to December 2015. The patients were divided into two groups based on the age<35 (n=758) and ≥35 years old (n=939) , compare the basic data and pregnant outcomes of controlled ovarian hyerstimulation. Spearman correlation method was conducted to analyze the relations between AMH and clinical outcomes. The logistic regression method and partial correlation analysis were used to judge the main factors which determine pregnancy outcomes by controlled the confounding factors. The receiver operating characteristic curve (ROC) was used to evaluate the predictive sensitivity and specificity of AMH. Results: In the group of PCOS patient younger than 35 years, AMH were correlated with the number of antral follicles (r=0.388) and retrieved oocytes (r=0.235) . When the effect of total dosage and starting dosage of gonadotropin were controlled, AMH was still significantly associated with the number of retrieved oocytes (P<0.05) . AMH had no predictive value for the clinical pregnancy of PCOS patient younger than 35 years (area under ROC curve=0.481, P=0.768) . In the group of PCOS patient≥35 years old, AMH were correlated with the number of antral follicles (r=0.450) , retrieved oocytes (r=0.399) , available embryo (r=0.336) and high quality embryo (r=0.235) . When the effect of total dosage and starting dosage of gonadotropin were controlled, the correlations were still significant between those indexes (all P<0.05) . AMH had no predictive value for the clinical pregnancy of PCOS patient ≥35 years old (area under ROC curve=0.535, P=0.560) . However, the clinical pregnancy rate of the group of PCOS patient ≥35 years old was slightly higher than the control group (P=0.062) . Conclusions: AMH has no predictive value for the pregnancy outcome of PCOS patient. The pregnancy rate of PCOS patient ≥35 years old is slightly higher than the younger group, because the PCOS patient may have better ovarian reserve.
目的: 探讨抗苗勒管激素(AMH)对不同年龄段多囊卵巢综合征(PCOS)患者辅助生殖治疗结局的预测价值。 方法: 纳入2014年1月至2015年12月在中山大学孙逸仙纪念医院行第1周期体外受精(IVF)或卵母细胞胞质内单精子注射(ICSI)治疗的PCOS不孕患者(PCOS组,284例)和其他因素不孕患者(对照组,1 413例)共1 697例;将所有患者分为年龄<35岁(758例)和≥35岁(939例),比较不同年龄段PCOS组与对照组患者基本资料、促排卵结局的差异,采用Spearman相关性分析AMH等指标与临床结局的关系,并采用偏相关分析法和logistics回归分析法控制各种混杂因素的影响后进一步分析AMH与各临床指标的关系,绘制受试者工作特征(ROC)曲线判断AMH对妊娠结局的预测价值。 结果: 在年龄<35岁的PCOS组患者中,AMH与窦卵泡数(r=0.388)、获卵数(r=0.235)呈正相关(P均<0.05);在控制促性腺激素(Gn)总量和Gn启动剂量的影响后,AMH与获卵数的正相关关系仍有统计学意义(P均<0.05)。AMH对年龄<35岁PCOS患者的妊娠结局无预测价值(ROC曲线下面积为0.481,P=0.768)。在年龄≥35岁的PCOS组患者中,AMH与窦卵泡数(r=0.450)、获卵数(r=0.399)、可利用胚胎数(r=0.336)、优质胚胎数(r=0.235)呈正相关(P均<0.05),在控制Gn总量和Gn启动剂量的影响后相关性仍存在(P均<0.05)。AMH对年龄≥35岁PCOS患者的妊娠结局无预测价值(ROC曲线下面积为0.535,P=0.560),但年龄≥35岁的PCOS组患者临床妊娠率略高于对照组(P=0.062)。 结论: AMH对PCOS患者辅助生殖治疗的妊娠结局无预测价值;年龄≥35岁的PCOS患者临床妊娠率略有升高,可能与高龄PCOS患者的卵巢储备功能更好有关。.
Keywords: Anti-Müllerian hormone; Polycystic ovary syndrome; Pregnancy outcome; Reproductive techniques, assisted.