The Correlation between AMH Levels in Serum and Follicular Fluid and the Number of Retrieved Oocytes During COH
-
摘要:
目的 研究控制性超促排卵（COH)过程中血清AMH的动态变化、大中卵泡液中AMH水平与获卵数的相关性。 方法 检测自然月经周期2～4 d基线（BL）、卵泡刺激第6天（S6）及扳机日（Trigger）血清中AMH值；检测大、中卵泡液中AMH值。分析血清AMH的动态变化，及其与获卵数的关系。比较大、中卵泡液中AMH水平与获卵数的关系。 结果 （1）血清AMH与获卵数呈正相关，BL与trigger、S6与trigger血清AMH有显著性差异P < 0.05；（2）大卵泡液AMH值与获卵数呈正相关，大、中卵泡液AMH差异有统计学意义P < 0.05；（3）AMH值从BL到S6呈缓慢上升，获卵数越多上升越明显；从S6到trigger日AMH值快速下降，获卵越多下降越明显。 结论 COH过程中，血清AMH呈波动变化，动态监测AMH值可预测获卵数；对Gn量的调整可能存在一定的指导意义。 Abstract:Objective To study the dynamic changes of serum AMH during different periods of treatment in patients who received the treatment of controlled ovarian hyperstimulation （COH） and to observe the correlation between AMH level in large and medium follicular fluid and the number of retrieved oocytes. Methods Serum AMH levels were measured on days 2-4 of natural menstrual cycle of baseline （BL）, day 6 of follicular stimulation （S6） and day trigger. The AMH levels in the fluid of large and medium follicles were detected. The dynamic changes of serum AMH and its relationship with the number of retrieved oocytes were analyzed. The relationship between the level of AMH and the number of retrieved oocytes was compared between large and medium follicular fluid. Results （1） There was a positive correlation between serum AMH and the number of retrieved oocytes. There was a significant difference in serum AMH between BL and trigger, S6 and trigger （P < 0.05）; （2） The value of AMH in large follicular fluid was positively correlated with the number of retrieved oocytes, and there was significant difference between large and medium follicular fluid （P < 0.05）; （3） The value of AMH increased slowly from BL to S6, and the more the number of retrieved eggs, the more obvious the increase; The AMH value decreased rapidly from S6 to trigger day, and the more oocytes were retrieved, the more obvious the decrease was. Conclusion Serum AMH fluctuates during COH, and dynamic monitoring of AMH can predict the number of retrieved oocytes; There may be some guiding significance for the adjustment of Gn. -
图 1 COH过程中不同获卵组血清AMH的动态变化趋势
Figure 1. Dynamic changes of serum AMH in different oocyte retrieval groups during COH
表 1 不同时段AMH值比较（ng/mL）
Table 1. Comparison of serum AMH level at different time points （ng/mL）
分组 中位数 百分位数（P） χ2 P 25 75 血清BL值 3.32 1.85 5.01 52.051 < 0.001 S6日AMH值 3.23 1.72 5.15 trigger日AMH值 1.63 0.83 2.70 
下载: 导出CSV
表 2 不同时段AMH值两两比较
Table 2. Comparison of AMH value between each two groups at different time point
比较组 Z P 血清BL值与S6日AMH值 0.159 0.874 S6日AMH值与trigger日AMH值 7.557 < 0.001 血清BL值与trigger日AMH值 7.817 < 0.001
下载: 导出CSV
表 3 AMH（ng/mL）值与女方年龄作相关性分析
Table 3. Correlation between AMH （ng/ml） value and age of women
项目 BL S6 trigger 大卵泡液 中卵泡液 女方年龄 r −0.308 −0.268 −0.267 −0.217 −0.150 P 0.006* 0.017* 0.018* 0.055 0.188 *P < 0.05。
下载: 导出CSV
表 4 不同年龄AMH检测结果的比较[（
$\bar x \pm s $ ），ng/mL]Table 4. Comparison of the results of AMH in different age groups [（
$\bar x \pm s $ ），ng/mL]女方年龄 n BL S6 trigger 大卵泡液 中卵泡液 ≤35岁 153 4.29 ± 3.14 4.08 ± 2.83 2.14 ± 1.68 3.99 ± 4.16 3.07 ± 2.69 > 35岁 24 2.11 ± 1.14 2.46 ± 1.59 1.16 ± 0.89 1.93 ± 1.38 1.84 ± 2.51 比较（t、P） t 11.283 7.422 7.687 5.809 4.425 P 0.001* 0.007* 0.006* 0.017* 0.037* *P < 0.05。
下载: 导出CSV
表 5 大、中卵泡液AMH值比较（ng/mL）
Table 5. Comparison of AMH levels between large and medium follicles （ng/mL）
分组 中位数 百分位数（P） Z P 25 75 大卵泡 2.52 1.33 4.51 2.651 0.009 中卵泡 2.21 1.2 3.98 经配对秩和检验，同一患者中，大、中卵泡液AMH值存在显著性差异（P = 0.009），大卵泡AMH值比中卵泡AMH值高。
下载: 导出CSV
表 6 血清及卵泡液AMH水平与获卵数的相关性
Table 6. Correlation of AMH levels in serum and follicular fluid with the number of retrieved oocytes
BL S6 trigger 大卵泡液 中卵泡液 获卵数 r 0.392 0.419 0.315 0.171 0.117 P < 0.001* < 0.001* < 0.001* 0.026* 0.123 *P < 0.05。
下载: 导出CSV
表 7 AMH值与获卵数的比较[ M（P25，P75）]
Table 7. Comparison between AMH value and the number of retrieved oocytes [ M（P25，P75）]
获卵数 基础AMH S6AMH trigger日AMH 大卵泡液AMH 中卵泡液AMH < 5 1.19（0.79，2.47） 1.11（0.87，1.98） 0.71（0.48，1.11） 1.61（0.49，2.11） 1.55（0.61，2.60） 6～10 2.24（1.63，3.62） 2.11（1.48，4.07） 1.12（0.69，2.18） 2.59（1.15，4.55） 1.76（0.81，4.43） 11～15 3.89（2.26，5.52） 3.30（2.24，5.60） 1.82（1.15，2.67） 2.57（1.42，4.37） 213（1.38，3.70） > 15 4.37（2.82，6.51） 4.96（3.44，6.57） 2.44（1.41，3.47） 2.82（1.75，5.07） 2.55（1.48，4.30） χ2 40.263 39.425 23.596 7.877 7.846 P < 0.001 < 0.001 < 0.001 0.049 0.049
下载: 导出CSV
表 8 4组获卵数 AMH值两两比较
Table 8. Comparison of that numb of oocytes retrieve from the four groups and AMH value between the two groups
比较组 基础AMH S6AMH trigger日AMH 大卵泡液AMH 中卵泡液AMH Z P Z P Z P Z P Z P 一组与二组 2.453 0.014 3.207 0.001* 2.362 0.018 1.826 0.068 1.187 0.235 一组与三组 4.341 < 0.001* 4.616 < 0.001* 3.690 < 0.001* 2.427 0.015 2.149 0.032 一组与四组 5.057 < 0.001* 5.465 < 0.001* 4.522 < 0.001* 2.696 0.007* 2.526 0.012 二组与三组 3.154 0.002* 2.859 0.004* 2.196 0.028 0.509 0.611 1.235 0.217 二组与四组 4.541 < 0.001* 4.535 < 0.001* 3.588 < 0.001* 1.069 0.285 1.607 0.108 三组与四组 1.411 0.158 2.173 0.030* 1.882 0.060 0.670 0.503 0.733 0.464 *P < 0.001。
下载: 导出CSV
-
[1] 邹宝玉. 抗苗勒氏管激素(AMH)预测卵巢储备功能及反应性的研究[J]. 中国优生与遗传杂志,2018,26(08):110-125. [2] 王含必,邓成艳. 抗苗勒管激素的生理及在临床应用中的新进展[J]. 生殖医学杂志,2021,30(02):257-261. [3] Sopa N,Larsen E C,Westring H H,et al. An AMH-based FSH dosing algorithm for OHSS risk reduction in first cycle antagonist protocol for IVF/ICSI[J]. Eur J Obstet Gynecol Reprod Biol,2019,237:42-47. [4] Li H,Ko J,Lee V,et al. Comparison of antral follicle count and serum anti Mullerian hormone level for determination of gonadotropin dosing in in-vitro fertilization:randomized trial[J]. Ultrasound Obstet Gynecol,2020,55(3):303-309. doi: 10.1002/uog.20402 [5] 王冬雪,吴小华. 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[J]. 中华生殖与避孕杂志,2017,37(2):111-116. [6] 莫辉,王华为,王港,等. 抗苗勒管激素水平与卵巢反应性的相关性分析[J]. 实用妇产科杂志,2020,36(1):62-66. [7] 何艺磊,李蓉,乔杰. 抗苗勒管激素在性腺相关疾病中的应用[J]. 实用妇产科杂志,2017,33(11):822-826. [8] 邵静宜,马艳萍,李云秀. 抗苗勒氏管激素与生殖[J]. 中国优生与遗传杂志,2012,20(5):13-15. [9] Peigne M,Decanter C. Serum AMH level as a marker of acute and long-term effects of chemotherapy on the ovarian follicular content:a systematic review[J]. Reprod Biol Endocrinol,2014,12:26. [10] Fleming R,Kelsey T W,Anderson R A,et al. Interpreting human follicular recruitment and antimullerian hormone concentrations throughout life[J]. Fertil Steril,2012,98(5):1097-1102. doi: 10.1016/j.fertnstert.2012.07.1114 [11] 陈雅,叶碧绿,郑九嘉,等. 血清及卵泡液抗苗勒管激素在多囊卵巢综合征患者体外受精促排卵治疗中的价值[J]. 中国临床药理学与治疗学,2015,20(12):1405-1411. [12] 王起来,马寅芙,付建华,等. 血清和卵泡液抗苗勒管激素在IVF-ET中的检测价值[J]. 中国实验诊断学,2017,21(12):2062-2064. doi: 10.3969/j.issn.1007-4287.2017.12.006 [13] 徐鑫. 血清抗苗勒管激素对高龄女性体外受精—胚胎移植临床妊娠的预测价值[D]. 长春: 吉林大学硕士学位论文, 2018. [14] Jamil Z,Fatima S S,Ahmed K,et al. Anti-Mullerian Hormone:Above and Beyond Conventional Ovarian Reserve Markers[J]. Dis Markers,2016,16:5246217. [15] Mashiach R,Amit A,Hasson J,et al. Follicular fluid levels of anti-Mullerian hormone as a predictor of oocyte maturation,fertilization rate,and embryonic development in patients with polycystic ovary syndrome[J]. Fertil Steril,2010,93(7):2299-2302. doi: 10.1016/j.fertnstert.2009.01.125 [16] 高变变,马晓龙,杨玲玲,等. 血清及卵泡液AMH水平与IVF-ET妊娠结局关系的探讨[J]. 宁夏医科大学学报,2020,42(7):659-663. [17] Tramisak M T,Panic H L,Cavlovic K,et al. Follicular fluid anti-Mullerian hormone:a predictive marker of fertilization capacity of MII oocytes[J]. Arch Gynecol Obstet,2015,291(3):681-687. doi: 10.1007/s00404-014-3460-9 -
点击查看大图
计量
- 文章访问数: 2438
- HTML全文浏览量: 1730
- PDF下载量: 12
- 被引次数: 0
