多囊卵巢综合征患者降调后抗苗勒管激素水平对妊娠结局的预测价值

【目的】探讨多囊卵巢综合征（PCOS）患者降调后抗苗勒管激素（AMH）水平对妊娠结局的预测价值。【方法】行体外授精／卵胞浆内单精子注射一胚胎移植（IVF／ICSI-ET）PCOS患者37例（PCOS组），同期单纯输卵管因素不孕行IVF／ICSI-ET患者37例（对照组），因发生卵巢过度刺激综合征（0HSS）或为避免发生OHSS而取消或放弃移植的患者为取消组。所有患者均使用黄体期长效促性腺激素释放激素激动剂（GnRH-a）方案，降调节后月经来潮d2～d。测血清AMH、性激素水平，阴道B超检查窦卵泡计数（AFc）。【结果】降调节后两组AMH、雄激素（T）、AFC、获卵数、受精卵数比较差异有显著性（P〈0．05），妊娠率比较无显著性差异（P〉0．05）；PCOS患者取消组AMH水平显著高于阴性妊娠结局组及阳性妊娠结局组（P〈0．05）；发生OHSS的PCOS患者AMH水平显著高于未发生OHSS组（P一0．02）；PC0s组降调节后AMH水平与T、AFC、HCG注射日雌二醇（E2）水平相关系数分别为0．524、0．352、0．524（P〈0．05）；对照组AMH与AFC、HCG注射日E2水平、获卵数、受精卵数、优质胚胎数相关系数分别为0．608、0．418、0．639、0．675、0．581（P〈0．05）。【结论】降调后AMH水平能反映正常卵巢女性降调后窦卵泡水平，提示注射HCG日E。峰水平，预测超促排卵（COH）中促性腺激素（Gn）使用量，获卵数，受精卵数，优质胚胎数。对PCOS患者，调后低水平AMH提示妊娠阴性结局可能，高水平则发生OHSS风险增加。

Value of Anti-mullerian Hormone of Patients with Polycystic Ovary Syndrome after Down-regulation for the Prediction of Pregnancy Outcome

Objective]To explore the value of antimullerian hormone（AMH） of patients with,polycystic ovary syndrome （PCOS） after downregulation for the prediction of pregnancy outcome. Methods] Thirty seven PCOS patients undergoing in vitro fertilization/intracytoplasm single spermatozoa injectionembryo transplantation（IVF/1CSIET） were chosen as PCOS group, meanwhile 37 cases of infertility caused by simple tubal factors undergoing IVF/ICSIET were chosen as the control group. The patients who cancelled or abandoned the transplantation for the occurrence of ovarian hyperstimulation syndrome （OHSS） or avoiding its occurrence were selected as the cancel group. All these cases received longacting gonadotrophin relea sing hormone agonist（GnRHa） protocol. After upregulation, serum levels of AMH and sex hormones were measured at dz d5 of menstrual cycle. Vaginal ultrasonography was used for detecting antral follicle count（AFC）. Results]After upregula tion, there were significant differences in serum levels of AMPI, testersterone（T）, AFC, retrieved oocytes and fertilized oo＇ cytes after upregulation between two groups（ P d0.05）, but there was no significant difference in pregnancy rate between two groups（ P ~0. 05）. The level of AMH level in PCOS patients of the cancel group was remarkably higher than that in the groups with negative and positive pregnancy outcome（ P d0.05）. The level of AMH in PCOS patients with OHSS was higher than that in PCOS patients without OHSS（/9 = 0.02）. After downregulation, the coefficient correlation of AMH in PCOS group with T, AFC and Ez level at the day of HCG injection was 0. 524, 0. 352 and 0. 524, respectively（ P d0.05）. The coef ficient correlation of AMH in the control group with AFC, Ez level at the day of HCG injection, retrieved oocytes, fertilized o ocytes and good quality of embryos was 0. 608, 0. 418, 0. 639, 0. 675 and 0. 581, respectively（ P d0.05）. Conclusion] Serum level of AMH after downregulation can reflect the AFC of women with normal ovary, which suggests that E2 peak level at the day of HCG injection can predict the dosage of Gn during controlled ovarian hyperstimulation（COH）, the number of retrieved oocytes, fertilized ovum and good quality of embryos. After downregulation, low level of AMH suggests the negative preg nancy outcome, while high level of AMH suggests the increased risk of OHSS.