| Background:In order to individualize the controlled ovarian hyperstimulation (COH) protocol and achieve enough amount of oocyte for fertilization during IVF-ET, the assessment of ovarian reserve and prediction of ovarian response is necessary. Recently serum Anti-Mullerian Hormone (AMH) and Inhibin B (INHB) have been evaluated as useful markers for ovarian reserve, ovarian response, and pregnancy outcome. However, the results from different studies are contradictory.Objective:to analyze whether serum Anti-Mullerian hormone (AMH) and inhibin B (INHB) are associated with ovarian reserve and pregnancy outcome in ART.Methods:A total of4426patients who underwent the first IVF/ICSI-ET cycle at the Reproductive Hospital Affiliated to Shan Dong University between March1, and November30,2013were retrospective reviewed in the study. On the day1st-3rd of the menstrual cycle before initiating treatment, peripheral blood for assay of serum Anti-Mullerian hormone, Inhibin B, and basal FSH were collected and transvaginal ultrasound scan were performed. Age, BMI, total dosage of gonadotropin used, number of oocytes retrieved, and pregnancy outcome were recorded. All the patients undergoing IVF/ICSI-ET used regular long or short protocol. The dosage of gonadotropin was adjusted given sequential transvaginal sonography and the levels of serum E2, P, and LH.6,000-8,000IU of hCG was given when at least two follicles with diameter≥18mm were detected. Egg collection was planned36h after hCG injection. According to the number of oocytes retrieved, the patients were divided into3groups, poor-responders with≤3oocytes retrieved, normal-responders with4-15oocytes retrieved and high-responders with≥15oocytes retrieved. Additionally, patients were divided into clinic pregnant group and non-clinic pregnant group according to whether gestation sac was present or not.Results:(1) Significant difference was observed among poor-responders, normal-responders, and high-responders in age, serum AMH, INHB, basal FSH, AFC, BMI, and total dosage of gonadotropin used (P<0.05). The levels of serum AMH, INHB, and AFC in poor responder group were lower than that in normal group and high group (median:0.79vs.2.07vs.3.69;39.32vs.55.05vs.61.78;7vs.12vs.16, respectively, P<0.05). Age, basal FSH, and BMI (median:35vs.31vs.29;8.04vs.6.64vs.5.9;23.18vs.22.58vs.22.04, respectively) showed decreasing pattern in each group (P<0.05).(2) AFC and serum AMH were superior predictors of the number of oocytes retrieved, compared with basal FSH, age, BMI, and INHB. Association was found between the number of oocytes retrieved and AFC, AMH, and INHB. Statistically inverse correlation between oocytes retrieved and basal FSH, BMI, and age was observed.(3) The cut-off value of serum AMH level for poor response was1.27ng/ml (ROC-AUC=0.816, sensitivity70.9%, specificity79.4%). The cut-off value for hyper response was2.71ng/ml (ROC-AUC=0.753, sensitivity71.0%, specificity67.6%). The ROC-AUC of INHB were non-significant in predicting poor and hyper response (ROC-AUC=0.669; ROC-AUC=0.558, respectively). The cut-off value of INHB level for poor response was39.78pg/ml (sensitivity51.8%, specificity75.8%) and the cut-off value for hyper response was44.4pg/ml (sensitivity75.9%, specificity36.4%).(4) Significant difference existed between the clinic pregnant group and non-clinic pregnant group in serum AMH, INHB, AFC, and age (P<0.05), except for basal FSH (P<0.05). In Multiple logistic regression analysis, age and AFC entered the model. And age had greater statistical significance in predicting pregnancy outcome (regression coefficient:-0.067). However, the performance of AFC was quite poor with the regression coefficient0.026.Conclusions:(1) Serum AMH and AFC have similar predictive accuracy for ovarian reserve and ovarian response superior to basal FSH and INHB.(2) Age shows prognostic value for pregnancy outcome. The prognostic value of serum AMH and INHB for pregnancy outcome is limited. |
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