The Significance Of AMH In The Selection Of Assisted Pregnancy Programs For Patients With Diminished Ovarian Reserve

Objective:Diminished ovarian reserve(DOR)are refers to the ovaries can raise fewer follicles or oocyte quality decline.DOR patients often need assisted reproductive technology(ART)to give birth.Research shows that anti-mullerian hormone(AMH)has a low fluctuation in the female menstrual cycle and can be detected at any time.There are patients in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI).Controlled ovarian hyperstimulation(COH)for IVF/ICSI included gonadotropin releasing hormone antagonist(GnRh-ant)and progestin-primed ovarian stimulation program(PPOS),short effect long program,short program,improved short program,super long program,micro stimulus program,etc.At present,low oocytes harvest,high cost of treatment and high rate of early miscarriage are still problems for DOR patients undergoing IVF/ ICSI-ET assisted pregnancy treatment.Therefore,it is particularly important to find appropriate pregnancy assisted schemes for DOR patients.Since AMH can be used as an important indicator for evaluating ovarian reserve,this study was intended to preliminarily evaluate the significance of AMH in IVF/ ICSI-ET for DOR patients,so as to lay a foundation for selecting appropriate pregnancy assistance schemes for DOR patients based on AMH.Methods:A retrospective analysis was performed on 109 IVF/ ICSI-ET cycles in the reproductive center of our hospital from January 1,2016 to October 31,2019 that met the DOR diagnosis.The cycles were divided into two groups according to their AMHlevels: group A:AMH<1.1ng/ml;Group B:AMH?1.1ng/ml.Collecting patients' age,body mass index(BMI),infertility,fixed number of year,the menstrual detection in patients with 2-3 days base gonadotropin(FSH),basic luteinizing hormone(LH),estradiol(E2),basis antral follicle count(AFC),serum AMH deteced on any day,According to different specification stimulate ovulation scheme for ultra stimulate ovulation treatment,and records for row(designed.the Gn start quantity,total designed.the Gn),laboratory outcome(number of retrieved oocytes,MII oocytes,portable embryo number,high quality embryo number,high quality embryo rate)and the clinical outcome(growing rate,clinical pregnancy rate,live births rate and miscarriage rate).Age,BMI,years of infertility,basic endocrinology,basic AFC,Gn start volume,Gn total,number of retrieved oocytes,number of MII oocytes,number of transplanting embryos,number of high-quality embryos,rate of implantation,rate of clinical pregnancy,rate of live birth and rate of miscarriage were compared between the two groups.Results:The age,BMI and years of infertility between the two groups are no significant difference(P>0.05).There was no significant difference in the level of basal LH and basal E2(P>0.05),but the level of basal FSH in group A was higher than that in group B(9.59±5.03 VS 7.65±3.00,P<0.05),and the level of basal AFC was lower than that in group B(5.83±2.80 VS 7.60±2.83,P<0.05).Gn starting quantity in group A was less than that in group B(193.97±67.91 VS 228.49±74.52,P<0.05),but there was no significant statistical difference in the total Gn(P>0.05).The number of obtained oocytes,MII oocytes,transplanting embryos and high-quality embryos in group A was lower than that in group B(3.51±3.08 VS 6.26±3.53,3.35±2.72 VS 5.37±3.03,2.78±2.93 VS 4.18±2.37,1.80±1.91 VS 2.65±1.89,P<0.05),but there was no significant difference in the rate of high-quality embryos(P>0.05).In addition,there was no significant difference in clinical outcome(implant rate,clinical pregnancy rate,live birth rates and miscarriage rate)between the two groups(P>0.05).Conclusion:As with previous studies,this research also argues that AMH is a important index in evaluating ovarian function,are patients AMH level and the number of oocytes,and MII oocytes number,high quality embryo number,portable embryos were positively correlated,while the AMH is a relatively independent indexes in evaluating ovarian reserve,but not as predicting clinical outcome in patients with are(growing rate,clinical pregnancy rate,live births rate,miscarriage rate).