超促排卵过程中抗苗勒管激素动态变化及其与临床结局的相关性

目的探讨血清及卵泡液(follicular fluid,FF)中抗苗勒管激素(AMH)在控制性超促排卵(COH)过程中的动态变化及其与COH结局的相关性分析。方法选取因输卵管因素和/或男方因素行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的周期,随机分为长方案组(n=38)和非降调节组(n=38)。长方案组和非降调节组分别于前一月经周期第2或第3日(基础日)、降调节期间月经第2或第3日、促性腺激素(Gn)启动日、Gn启动第5日(Gn5)、诱发排卵日(h CG注射日)、取卵前1日和取卵后3 d抽取外周静脉血。取卵日收集直径≥18 mm(大)、14~17 mm(中)、14 mm(小)的FF。结果降调节后血清AMH水平在Gn启动日较基础日显著升高,2种COH方案随外源性Gn使用时间的增加血清AMH降低;随卵泡直径增大,FF中AMH降低。Gn5血清AMH与获卵数、MⅡ卵数和可利用胚胎数相关性最强,中FF的AMH与窦卵泡数(AFC)、Gn用量和可利用胚胎相关性较好。结论降调节显著升高AMH水平,增加可募集AFC及改善卵泡发育同步化,提示可依此调整Gn用量,外源性Gn使用后AMH水平逐渐降低;Gn5血清AMH水平可预测IVF/ICSI-ET结局。

Anti-Müllerian hormone dynamics during controlled ovarian hyperstimulation and its correlation with clinical outcomes

Objective To evaluate the dynamics of anti-Müllerian hormone (AMH) of serum and follicular fluid (FF) during controlled ovarian hyperstimulation (COH) and to analyze the relationship between AMH and outcomes of COH.Methods A total of 76 eligible IVF/ICSI-ET cycles owing to the tubal or male factors were studied,which were randomly grouped into GnRH-a long protocol and non pituitary down regulation protocol.Serum AMH levels were measured at day 2/3 of previous menstrual cycle (baseline),day 2/3 of menstrual during down regulation,the day of Gn starting,day 5 of Gn stimulation (Gn5),day of hCG administration (dhCG),the day before oocyte retrieval and 3 d after oocyte retrieval.FF was grouped into huge (≥ 18 mm),middle (14-17 mm) and small (＜ 14 mm) depending on diameters.Results Serum AMH level was significantly higher on the day of Gn staring compared with baseline after the GnRH-a.AMH was gradually decreased with exogenous Gn administration during COH.AMH in FF was gradually decreased with follicles' diameter increasing.There was the strongest correlation between AMH of Gn5 and number of retrieved oocytes,the number of Mn and embryos' conditions during COH.AMH in middle FF was significantly related with antral follicle count (AFC),Gn used dosage and number of available embryos.Conclusions AMH level is significantly elevated after pituitary down regulation,and this augments the number of recruited follicles and improves follicle synchronization.In addition,we can adjust Gn used dosage depending on AMH level of Gn starting.AMH is gradually decreased with exogenous Gn using.At Gn5 serum AMH level may be a better predictive marker of the outcomes of IVF.