Clinical Study On The Effect Of In Vitro Fertilization-embryo Transfer And The Early Diagnostic Criteria Of Anti-muller Hormone In Premature Ovarian Insufficiency

[Objective]By analyzing the efficacy of assisted reproductive technology(ART)in patients with early-onset ovarian insufficiency(POI)and the factors affecting the pregnancy outcome in patients with POI,and exploring the critical value and predictive value of anti-Muller hormone(AMH)on the cancellation of transplant cycle and clinical pregnancy in patients with POI,and providing evidence for the inclusion of AMH in the early diagnostic criteria of POI.It is helpful for the early diagnosis and timely treatment of POI patients,and provides reference for the clinical diagnosis and treatment of POI patients.[Methods]Clinical data of patients admitted to Reproductive Center of Southern Medical University from January 2016 to February 2022 were retrospectively analyzed and divided into POI group(FSH≥25IU/L),DOR group(FSH≥10IU/L,AMH≤1.1ng/ml,AFC<5-7)and normal control group(FSH 5-10IU/L).The pregnancy-assisted effect of IVF in different groups was compared,and POI patients were further grouped according to the number of eggs obtained and ages,to analyze the influencing factors of pregnancy outcome in POI patients,and to explore the critical value and predictive value of AMH for cycle cancellation and clinical pregnancy in POI patients due to unavailable embryos.The POI patients were grouped according to the critical value,and the characteristics of menstrual cycle and related indexes of ovarian reserve were analyzed in each group.SPSS25.0 software was used for statistical analysis..[Results]1.The clinical pregnancy rate and live birth rate were significantly different among different groups(P<0.01),POI group<DOR group,control group,the difference was significant;There was no significant difference in abortion rate among different groups(P>0.05).2.Receiver operating characteristic curve analysis of AMH as the cut-off point for predicting poor ovarian response in POI patients was 0.445ng/ml,the area under the AMH curve(AUC)was 0.780,the sensitivity was 90.0%,and the specificity was 54.8%.The cut-off point value of AMH for predicting cancellation of transplantation cycle in POI patients was 0.235ng/ml,AUC was 0.682,sensitivity was 85.7%,and specificity was 45.9%.AFC was used as the cut-off point value of 3 for predicting the cancellation of transplantation cycle in POI patients,AUC was 0.659,sensitivity was 64.7%,and specificity was 66.7%.The AUC of AMH combined with AFC for predicting the cancellation of transplantation cycle in POI patients was 0.711,the sensitivity was 79.0%,and the specificity was 61.1%;the cut-off point value of AMH for predicting clinical pregnancy in POI patients was 0.680ng/ml,AUC was 0.625,and the sensitivity was 58.7%,the specificity was 66.4%.3.There were no significant differences in AMH level between AMH>0.680 group and control group(FSH 5-10IU/L)(P>0.05).There was no significant difference in FSH level between AMH≥0.680 group and 0.235<AMH<0.680 IU/L group.[Conclusion]1.The pregnancy outcome of POI patients was relatively poor,the transplant cycle cancellation rate was high,the clinical pregnancy rate and live birth rate were significantly lower than that of the control group and DOR group,but the abortion rate did not increase.2.The diagnostic test accuracy of AMH combined with AFC in predicting transplant cycle cancellation in POI patients is higher.3.Patients with POI should be actively treated with ART until AMH level drops to 0.235ng/ml and/or AFC level drops to 3.4.Based on the outcomes of IVF Treatment in patients with POI,the early diagnostic criteria of AMH for biochemical POI are suggested as follows:basal FSH level≥10IU/L,AMH<0.445-0.680ng/ml.