The Correlation between AMH Levels in Serum and Follicular Fluid and the Number of Retrieved Oocytes During COH
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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 
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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
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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。
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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。
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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。
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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。
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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
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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。
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