关键词: 抗苗勒管激素, 多囊卵巢综合征, 促性腺激素, 获卵数, 临床妊娠率

Abstract:

Objective To discuss the relationship between the different serum levels of anti-mullerian hormone （AMH） and ovarian response and in vitro fertilization-embryo transfer （IVF-ET）-assisted pregnancy outcome of the infertile patients with polycystic ovary syndrome （PCOS）， and to clarify the influence of serum AMH level on assisted pregnancy outcome of the PCOS patients， and to provide the basis for the selection of assisted pregnancy treatment in the PCOS patients. Methods A total of 1 837 patients aged 21－39 years old who underwent IVF-ET-assisted pregnancy were selected and divided into PCOS group （n=910） and non-PCOS group （n=927） according to whether they were diagnosed as PCOS； a total of 437 patients in PCOS group received fresh single high-quality blastocyst transfer， and they were divided into AMH< 7 μg·L^－1 group and AMH≥7 μg·L^－1 group according to their serum AMH levels；the patients were divided into 20－24 years old group， 25－29 years old group， 30－34 years old and 35－39 years old group according to their ages.Age，serum levels of AMH， gonadotropin（Gn） dosages， estradiol （E2） values on the human chorionic gonadotropin （HCG） day， number of retrieved oocytes，cancellation transfer rates for preventing ovarian hyperstimulation syndrome （OHSS） and clinical pregnancy rates of the patients in PCOS group and non-PCOS group were compared；the Gn dosages， E2 values on the HCG day， number of retrieved oocytes，cancelation transfer rates of preventing OHSS and clinical pregnancy rates of the patients with different AMH levels in PCOS group were analyzed；the serum AMH levels of the patients with different ages in pregnant group and non-pregnant group were compared. Results The level of serum AMH and E2 _{value on the HCG day， number of retrieved oocytes and cancelation transfer rate for preventing OHSS of the patients in PCOS group were higher than those in non-PCOS group （P<0.05）， while the Gn dosage and clinical pregnancy rate were lower than those in non-PCOS group （P<0.05）.The serum AMH level of the patients in PCOS group was positively correlated with the E2 value on the HCG day and number of retrieved oocytes（r=0.502，P=0.001；r=0.233，P=0.001）， and negatively correlated with Gn dosage（r=－0.400，P=0.001）.In PCOS group，compared with AMH< 7 μg·L^－1 group， the E2 value on the HCG day， number of retrieved oocytes， and cancelation transfer rate for preventing OHSS of the patients in PCOS group were increased （Z=－3.952， P=0.001； Z=－2.858， P=0.004； χ² = 23.154， P=0.001）； the Gn dosage and clinical pregnancy rate were decreased（Z=－6.727， P=0.001； χ² = 6.640， P=0.010）. The serum AMH level of the patients in pregnant group in PCOS group was lower than that in non-pregnant group（Z=－4.192， P=0.001）； in 25－29 years old group and 30－34 years old group， the serum AMH levels of the patients in pregnant group were lower than those in non-pregnant group（Z=－2.197， P=0.028，Z=－3.700，P<0.001）. Conclusion For the PCOS patients with serum AMH level≥7 μg·L^－1，the pretreatment should be performed to reduce the AMH level before assisted pregnancy. In the process of IVF-ET-assisted pregnancy， the Gn dosage should be well controlled to reduce the E2value on the HCG day， reduce the cancellation transfer rate for preventing OHSS， try to have the chance of fresh embryo transplantation and increase the clinical pregnancy rate， and improve the outcome of assisted pregnancy.}

Key words: Antimullerian hormone, Polycystic ovary syndrome, Gonadotropin, Number of retrieved oocytes, Clinical pregnancy rate