科研之友
微信
新浪微博
Facebook
分享链接
摘要
Anti-Mullerian hormone (AMH) is a sensitive marker of ovarian reserve. Some investigators have reported that AMH is the most sensitive predictor of both over-and under-response to controlled ovarian hyperstimulation (COH). The evidence for AMH as a marker of over-response is strong; however, evidence for its role as a marker of poor response is much weaker, and its value for prediction of poor response is questionable. Although several studies found no association of AMH with pregnancy and live birth rates in COH, others have. Therefore, a role for AMH in predicting pregnancy outcome is unproven. This retrospective study was designed to determine whether the new AMH-guided COH treatment protocols were more beneficial for assisted reproduction than conventional treatment protocols using chronological age and follicle-stimulating hormone (FSH) as markers of ovarian reserve. Clinical outcomes and cost were compared among 2 groups of women undergoing a first cycle of assisted reproduction using fresh embryos. One group of women (n = 346) was treated according to conventional stimulation protocols (n = 346); the second group (n = 423) was treated using the new AMH-tailored protocols (according to AMH levels). Use of the AMH-guided protocols increased embryo transfer rates significantly compared with conventional protocols (87.5% vs. 78.9%; P = 0.002). There was also a significant increase with the AMH protocol in the overall pregnancy rate per cycle started (17.9%-27.7%, P = 0.002) and live birth rate (15.9%-23.9%, P = 0.007). The AMH protocol was associated with a significantly lower incidence of the ovarian hyperstimulation syndrome from 6.9% to 2.3% (P = 0.002) and a nonsignificant decrease in the incidence of failed fertilization from 7.8% to 4.5% (P = 0.066). Following were economic benefits of using the AMH-guided protocols: overall cost for clinical management of ovarian hyperstimulation syndrome was reduced by 43% and cost of fertility drug treatment decreased by 29% per patient treated. It is possible that stimulation protocols involving the use of gonadotropin-releasing hormone (GnRH) antagonists contributed to the improved outcomes; however, there was no difference between the live birth rate among women treated with GnRH agonists or antagonists. These findings demonstrate that use of AMH-guided COH protocols for assisted reproduction is associated with significantly improved clinical outcomes, reduced complications, and substantial cost savings compared with conventional age-and FSH-guided protocols.
- 出版日期2011-12
