| Objective:To explore the predictive value of serum anti-mullerian hormone(AMH)levels on pregnancy outcome in patients with normal ovarian response after fresh cycle in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)-embryo transfer(ET),in order to provide reference for the prediction of clinical pregnancy outcome in patients with normal ovarian response..Method:Retrospective analysis was performed on the clinical data of 238 patients with normal ovarian response(NOR)who were admitted to the Reproductive Center of Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University from January 2018 to February 2022 for tubal factors and/or male factors and underwent fresh embryo transfer after the first ovulation cycle.In this study,according to the clinical data characteristics of the included patients and the grouping criteria of previous studies,the 75th percentile of AMH level was taken and the patients were divided into group A(AMH<3.12ng/ml,n=175)and group B(AMH≥3.12ng/ml,n=63),and the pregnancy outcomes of the two groups were compared.The main observation indexes were early abortion rate,live birth rate and premature birth rate,while the secondary indexes were clinical pregnancy rate,egg harvest,2PN number,total number of high-quality embryos,total number of available embryos,etc.Logistic regression was used to explore the influencing factors of early abortion,live birth and premature delivery.The predictive value of influencing factors on pregnancy outcome was evaluated by ROC curve.Results:1.The E2 on the day of injecting HCG in group B were higher than group A(2904.39±1245.91 VS 1980.64±971.07pg/ml),and the differences was statistically significant(P<0.001).2.The total number of follicles,the number of eggs obtained,the number of 2PN,the number of high-quality blastocysts,the total number of embryos frozen,the total number of available embryos and the total number of high-quality embryos in group B were higher than those in group A(13.27±4.60 VS 10.33±3.75,12.10±4.41 VS 9.69±3.61,7.03±4.04 VS 5.79±2.97,0.81 ± 1.27 VS 0.49±0.85,2.56±2.21 VS 1.91±1.97,4.56±2.37 VS 3.82±1.97,3.02±2.21 VS 2.30±1.93).The differences were statistically significant(P<0.05).3.The early abortion rate of group B was lower than that of group A(8.11%VS 32.08%),and the difference was statistically significant(P=0.004).4.There were no statistical difference in the incidence of obstetric complications between group A and Group B(P>0.05).5.There were no significant differences in implantation rate,embryo rate and pregnancy outcome among different ovulation induction regiments(P>0.05).6.Logistic regression analysis showed that AMH was a protective factor for early pregnancy loss and live birth in patients with normal ovarian response(OR=0.284,P<0.001;OR=0.614,P=0.008).The total number of high-quality embryos was also a protective factor for live birth in patients with normal ovarian response(OR=0.782,P=0.027).Twin pregnancy was a risk factor for preterm birth in patients with normal ovarian response(OR=10.587,P<0.001).7.ROC curve showed that AMH had certain predictive value for the occurrence of early pregnancy loss in patients with normal ovarian response.When AMH was 1.72ng/ml,the prediction effect of early pregnancy loss was the best,with sensitivity of 90.6%and specificity of 54.1%.AMH has a certain predictive value for live birth in patients with normal ovarian response.When AMH is 2.00ng/ml,the predictive value for live birth is the best,with sensitivity of 84.0%and specificity of 41.7%.8.Spearman correlation analysis showed that AMH was positively correlated with AFC,number of eggs obtained,number of 2PN,the total number of embryos frozen,the total number of available embryos and the total number of high-quality embryos(r>0,P<0.05),and negatively correlated with age(r<0,P<0.05).Conclusions:1.Low AMH may be associated with adverse pregnancy outcomes in patients with normal ovarian response.Patients with normal ovarian response with AMH less than 1.72ng/ml may be more prone to early abortion.Patients with normal ovarian response with AMH higher than 2.00ng/ml may be more likely to have a live birth.2.AMH may be related to oocyte quality in patients with normal ovarian response. |
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