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Objective

研究目的

To study how anti-mullerian hormone (AMH)levelin patients with polycystic ovary syndrome (PCOS) affects ovulation induction (OI) cycle cancellation rates. Pregnancy and live birth rates were secondarily analyzed.

研究多囊卵巢综合征患者中AMH水平对诱导排卵周期取消率的影响。妊娠率和活产率作为次要结局分析。

Materials and Methods

研究对象及方法

A multicenter, retrospective study of OI cycles conducted from September 1, 2018 through December 31, 2021 was performed. Patients included were infertile, 18-35 years old, with a body mass index (BMI) less than 40, and a diagnosis of PCOS, undergoing oral OI followed by timed intercourse (TIC) or intrauterine insemination (IUI). Patients with a coexisting infertility diagnosis were excluded. The datawas summarized using descriptive statistics for continuous variables (mean,standard deviation, and percentages) with Excel version 16.54. Statistical Analytics Software (SAS) version 9.4 was used to analyze continuous data by way of a mixed model logistic regression with covariates when necessary,while patient age and BMI were adjusted for via a multivariable regression model. A p-value < 0.05 was considered statistically significant.

多中心研究，回顾性纳入2018年9月1日至2018年12月31日间的诱导排卵周期。纳入对象为18-35岁，BMI＜40，有生育要求的多囊卵巢综合征患者，予口服药物诱发排卵，并指导同房（TIC）或人工授精（IUI）。排除多囊卵巢综合征合并不孕症患者。连续变量用均数、标准差、百分比表示，采用Excel 16.54的描述性统计进行汇总，必要时采用SAS 9.4 具有协变量的混合模型logistic回归进行分析，而患者年龄和BMI则采用多变量回归模型进行调整。P＜0.05认为差异具有统计学意义。

Results

研究结果

 A total of 420 cycles completed by 109 patients were included. AMH levels ranged from 0.92-54.8 ng/mL with an average of 10.4 ng/mL(SD 8). Clinical pregnancy was achieved in 47% of patients (n=52) and a live birth in 34% (n=37). A total of 6% (n=24) of OI cycles were cancelled for lack of ovarian response. Eighty-seven patients with an AMH level below 16 ng/mL completed 328 cycles of OI, averaging 3.7 OI cycles per patient. Of these 328 cycles, 4.6% (n=15) were cancelled and 10.4% (n=34) were redosed. Twenty-two patients with an AMH level above 16 ng/mL completed 90 cycles of OI, averaging 4.1 cycles per patient. In this group, 11.1% (n=10) of OI cycles were cancelled and 14.4% (n=13) were redosed. Patients with an AMH level above 16 ng/mL were significantly more likely to encounter cycle cancellation (p<0.05) and achieve a clinical pregnancy (p<0.05). These findings remained

significant after adjusting for age and BMI (p<0.05). 

纳入研究的109名患者共完成420个周期。AMH：0.92-54.8 ng/ml，均值10.4ng/ml（SD 8）。47%的患者（n=52）获得临床妊娠，34%的患者（n=37）获得活产。6%的诱导排卵周期（n=24）因卵巢无反应被取消。87名AMH＜16 ng/ml的患者共完成328个诱导排卵周期，平均每个患者完成3.7个周期。其中4.6%的周期（n=15）被取消，10.4%（n=34）重新给药。22名AMH＞16 ng/ml的患者共完成90个诱导排卵周期，平均每个患者完成4.1个周期。其中11.1%的周期（n=10）被取消，14.4%（n=13）重新给药。AMH＞16 ng/ml组周期取消率明显增高（P＜0.05），但临床妊娠率亦增高（P＜0.05）。调整患者年龄和BMI后，结果仍有统计学差异（P＜0.05）。

Conclusions

结论

PCOS patients with a high AMH level are at an increased risk of OI cycle cancellation despite an increased clinical pregnancy rate.

高水平AMH的多囊卵巢综合征患者，虽然临床妊娠率增加，但诱导排卵周期取消率亦增加。

Impact Statement

影响声明

Patients with PCOS and a high AMH level should be counseled on the risks of OI cycle cancellation based on their ovarian reserve. Fertility strategies, regardless of age or BMI, should be individualized.

高水平AMH的多囊卵巢综合征患者应根据其卵巢储备获悉其诱导排卵周期取消风险。无论患者年龄或BMI，生育策略均应个体化。

文章来源：high anti-mullerian hormone level predicts ovulation induction failure in patients with polycystic ovary syndrome.Wilhoite, Morgan N. et al.Fertility and Sterility, Volume 118, Issue 4, e314 - e315