【摘要】 目的探讨降调节前、后抗苗勒管激素(AMH)值有无变化以及何时检测对预测控制性卵巢刺激(COS)中卵巢反应性更有意义。方法选择2009年6～12月在我中心行体外授精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗患者159例,入选标准:年龄≤38岁,月经规律,基础卵泡刺激素(bFSH)≤10 IU/L,体重指数(BMI)在18～23,使用一致的黄体期长效促性腺激素释放激素激动剂(GnRH-a)长方案。降调节前、后月经来潮第2～5天分别抽取空腹静脉血检测AMH、性激素水平,抽血当天行阴道B超检查窦卵泡计数(AFC)。观察卵泡数、获卵数、可利用胚胎数、总促性腺激素(Gn)用量、妊娠结局。结果降调节前AMH(4.404±1.950)μg/L,降调节后AMH(3.229±0.857)μg/L,下降有统计学意义(P<0.001);降调节前AFC15.31个,降调节后AFC14.52个,差异有统计学意义(P<0.05);两因素相关分析结果显示降调节后AMH与卵泡数、卵子数、可利用胚胎数、使用的总Gn剂量相关系数分别为0.507、0.489、0.381、-0.343,均(P<0.01),比降调节前AMH的相关系数0.397(P<0.01)、0.305(P<0.01)、0.200(P<0.05)、-0.306(P<0.01)相关性更强;降调节后AMH和降调节前AMH与其他指标比较,与获卵数相关性更强,相关系数分别0.489(P<0.01)、0.305(P<0.01)。降调节后AMH与获卵数直线回归方程为Y=3.522+2.936X(μg/L)。结论在卵巢储备功能良好的患者中,降调节后的AMH较降调节前有所下降、与获卵数相关性更强。降调节后AMH每增加1μg/L,预期会增加约3个获卵数,较降调节前的AMH更能预测卵巢反应性。更多还原

【Abstract】 Objective:To investigate serum levels of anti-Müllerian hormone（AMH） before and after pituitary down-regulation and their association with ovarian response to controlled ovarian stimulation（COS）. Methods:A total of 159 eligible IVF cycles in our centre from Jun.2009 to Dec.2009 were studied. All these cycles were treated with,long gonadotrophin releasing hormone agonist（GnRH-a） protocol.The patients aged 22 to 38 years,with follicular stimulating hormone（FSH） levels≤10 U/L,regular menstrual cycle and body mass index（BMI） of 18 to 23.Serum was collected on the day 2-5 of menstrual cycle before and after pituitary down-regulation for the determination of AMH,estradiol（E₂）,FSH,luteinizing hormone（LH） and FSH/LH ratio.Antral follicle count（AFC,2-10 mm in diameter） was determined on the day of blood collection.The number of follicle retrieved oocytes,eligible embryos,total dose of gonadotropin used,and pregnancy outcomes were recorded. Results:Serum levels of AMH were significantly lower after pituitary down-regulation（3.229±0.857μg/L） than those before down-regulation（4.404±1.950μg/L）（P<0.001）.The serum AMH levels after down regulation were strongly correlated with follicle counts,oocytes retrieved,eligible embryos and total dose of gonadotropin（r= 0.507,0.489,0.381 and—0.343,respectively）（P<0.01）,stronger than the coefficients of serum AMH levels before down regulation with follicle counts（0.397,P<0.01）, oocytes retrieved（0.305,P<0.01）,eligible embryos（0.200,P<0.05） and total dose of gonadotropin （—0.306,P<0.01）.The correlation with oocytes retrieved from strong to weak was AMH concentrations after down-regulation（r=0.489,P<0.01）,AFC after down-regulation（r = 0.442,P<0.01）, AMH concentrations before down-regulation（r=0.305,P<0.01）,bFSH/bLH（r=-0.277,P<0.01）, AFC before down-regulation（r=0.247,P<0.01）,FSH/LH after down-regulation（r= -0.213,P<0.01） and bLH（r=0.194,P<0.05）.The liner regression equation of AMH after down-regulation with oocytes retrieved was Y = 3.522 + 2.936X.[Y is oocytes retrieved,X is AMH concentrations（μg/L）] Conclusions:After pituitary down-regulation,serum AMH concentrations significantly decreased.Serum AMH concentration after down-regulation could be a better predictor of ovarian response in COS.更多还原