The Diagnostic Value Of AMH For PCOS And The Influence Of Different AMHs On The Outcome Of PCOS Assisted Pregnancy

ObjectiveExplore the diagnostic value of serum anti-Müllerian hormone(AMH)levels for polycystic ovary syndrome(PCOS).Methods:This is a retrospective analysis of the data of patients who underwent Assisted Reproductive Technology(ART)at the Reproductive Medicine Center of Henan Provincial People’s Hospital for the first time from September 2018 to March 2021.They are included in the PCOS group or the non-PCOS(NPCOS)group.Compared the serum levels of AMH,testosterone(T),dehydroepiandrosterone sulfate(DHEA-S)and the number of antral follicles(AFC),and the diagnostic efficacy of each index and the combined index on PCOS was compared through the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Then the patients were divided into groups according to age,and by observing the ROC-AUC of different age groups,the diagnostic efficacy of serum AMH on PCOS was studied after age stratification.Results:(1)The average age of the PCOS group was(29.41±2.906)years,and the average age of the NPCOS group was(29.64±2.529)years,P>0.05.(2)Serum AMH value(8.35±4.816)ng/ml,T value(0.42±0.237)ng/ml,DHEA-S value(275.86±113.590)ng/ml,AFC number(22.56±2.882)of PCOS group were greater than serum AMH value of NPCOS group(3.05± 2.465),ng/ml T value(0.27±0.110)ng/ml,DHEA-S value(247.10±125.550)ng/ml,number of AFC(11.94±5.875),P<0.01.(3)The ROC-AUC of serum AMH in the diagnosis of PCOS is 0.865,the cut-off value is 4.3ng/ml,with 81.1% sensitivity and 75.8% specificity.The ROC-AUC of T is 0.747,and the cut-off value is 0.35ng/ml,with 59.3% sensitivity and 77.6%specificity.The ROC-AUC of DHEA-S is 0.572,and the cut-off value is 268.55ng/ml,with 46.7% sensitivity and 63.6% specificity.The ROC-AUC of AFC is 0.943,the cut-off value is 19.5,which shows 91.4% sensitivity and 76.9% specificity.Serum AMH,serum T,serum DHEA-S and AFC all have diagnostic significance for PCOS.The AUC of ROC is AFC>AMH>T>DHEA-S.(4)In the combined detection,the ROC-AUC of AMH+AFC was 0.948.The ROC-AUC of AMH+T is 0.874.The ROC-AUC of AMH+DHEA-S is 0.867.(5)After grouping by age,it is shown that only the ROC-AUC of serum AMH in the 35-40 age group is greater than the ROC-AUC of ungrouped serum AMH for PCOS diagnosis.With the increase of age,the cut-off value of each age group decreases.But the corresponding sensitivity and specificity did not increase.Conclusion:Serum AMH can be used for the diagnosis of PCOS.The cut-off value is 4.3ng/ml without age grouping,showing 81.1% sensitivity and 75.8% specificity.The combination of serum AMH and AFC can increase the diagnostic efficacy of AMH for PCOS,but age grouping failed to increase significantly the diagnostic efficacy of serum AMH for PCOS.ObjectiveExplore the outcome and clinical outcome of controlled ovulation induction in the process of in vitro fertilization/intracytoplasmic sperm injectio-embryo transfer(IVF/ICSI-ET)in patients with PCOS at different levels of AMH Impact.Methods:This is a retrospective analysis about PCOS patients of childbearing age who underwent IVF/ICSI assisted conception at Henan Provincial People’s Reproductive Medicine Center for the first time from September 1,2018 to March 1,2020.The serum AMH level was divided into three groups according to the quartile method,and the influence of serum AMH level on IVF/ICSI assisted pregnancy in PCOS patients was analyzed by comparing the basic situation,ovulation induction and clinical outcome of each group.Results:(1)There was no significant difference in age,years of infertility,b FSH,and b E2 among the three groups(P>0.5).In group L,group M,and group H,b LH and T increased in sequence,while BMI decreased in sequence(P<0.01);(2)After long-acting GnRH agonist long protocol,the difference of LH in the Gn starting day among the three groups was statistically significant(P<0.5).In group L,M,and H,the LH on the starting day of Gn increased in turn.There was no statistically significant difference in E2 and FSH on the starting day of Gn;(3)In groups L,M,and M,Gn dosage、 the total doses of Gn and the numbers of 2PN decreased sequentially,P < 0.05,but there was no statistically significant difference in the days of Gn;(4)The total number of harvested eggs and FORT increased gradually in group L,M,and H(P<0.01).There was no statistically significant difference in the 2PN rate,the number of available embryos and high-quality embryos in D3;(5)The live birth rate of fresh transplantation cycle in group H was lower than that in group L and group M,and the difference was statistically significant;(6)There was no statistically significant difference in the clinical pregnancy rate between the three groups of embryo thawing transfer(FET)cycles;(7)There was no statistically significant difference in the clinical pregnancy rates between the fresh cycle and the FET cycle between the L group and the M group.The clinical pregnancy rate and live birth rate of FET cycles in group H were higher than those of fresh cycles,and the difference was statistically significant.Conclusion:The AMH level can reflect the ovarian responsiveness of PCOS patients.In controlled ovulation stimulation,the fertility doctor can use the initial dose of GN more accurately to promote ovulation and provide patients with more ideal controlled ovulation stimulation results,in accordance with the level of AMH.