Correlation Between AMH Levels And Clinical Outcomes Of IVF/ICSI-ET In Patients With Poor Ovarian Response

Objective:To actively research the clinical significance of anti-Müllerian hormone levels in in vitro fertilization and embryo transfer/intracytoplasmic sperm injection assisted conception treatment in patients with poor ovarian response and the factors influencing the time to pregnancy in POR patients by assisted conception treatment,to optimise the clinical management of POR patients,to improve clinical outcomes in POR patients and to increase confidence in POR patients.Methods:Clinical data of patients who met the diagnostic criteria of poor ovarian response and received IVF-ET/ICSI assisted conception treatment at the Fertility Centre of Hospital from January 2019 to January 2021 were collected and followed up for at least 2years,they were grouped according to age and AMH level,and divided into low age group（<35 years old）and high age group（≥35 years old）according to age,with reference to Bologna diagnostic criteria.The patients were divided into three groups according to AMH level,group 1 with AMH<0.5ng/m L,group 2 with 0.5ng/m L≤AMH≤1.1ng/m L and group 3 with AMH>1.1ng/m L.General information,baseline endocrine levels,ovulation treatment,embryo culture and clinical outcomes were collected separately for statistical analysis to explore differences between groups;To investigate the factors associated with clinical pregnancy outcomes after assisted reproduction and the correlation between serum AMH levels and clinical pregnancy outcomes.The time to clinical pregnancy in patients with poor ovarian response to assisted conception was counted,Kaplan-Meier survival analysis was used to estimate pregnancy rates,and differences were compared using the log-rank test,followed by a COX model multifactorial analysis of independent influences on TTP.Results:In the high age group,the cumulative pregnancy rate was 22.2%,44.9%and61.1%,and the cumulative live birth rate was 19.6%,33.7%and 55.6%in the three groups with different AMH levels,respectively.The statistical results showed that the clinical pregnancy rate,live birth rate,cumulative pregnancy rate and cumulative live birth rate increased with increasing AMH levels,and the differences between groups were statistically significant（P<0.05）.There was no statistically significant difference in the early miscarriage rate per transplant cycle between the higher and lower age groups with different AMH levels.In a univariate analysis using clinical pregnancy as an indicator,age（P<0.001）,AMH level（P<0.001）,type of infertility（P=0.006）,E₂ level on HCG day（P=0.031）,number of eggs gained（P=0.005）and number of embryos transferred（P=0.016）were the relevant factors affecting pregnancy outcome;further multifactorial Logistic regression analysis showed that age（OR=0.917,95%CI=0.867-0.96,P=0.002）,AMH level（OR=2.187,95%CI=1.240-3.857,P=0.007/OR=5.601,95%CI=2.829-11.091,P<0.001）,number of embryos transferred（OR=1.681,95%CI=1.001-2.823,P=0.048）.Of the 300 POR patients assisted with IVF/ICSI,108 achieved a clinical pregnancy and the remaining 192（64%）did not,with a median time to clinical pregnancy estimated at 32 months for all patients enrolled.COX regression modelling showed that age and AMH were independent influences on TTP.Conclusions:1.Age and AMH levels are important indicators to assess pregnancy outcome in POR patients.2.Older patients with poor ovarian reserve have poorer pregnancy outcomes,but younger patients with poor ovarian reserve can still achieve good pregnancy outcomes with aggressive fertility treatment.3.Advanced age is an independent risk factor for clinical pregnancy in POR patients,while AMH level and number of embryos transferred are independent protective factors for clinical pregnancy outcome in POR patients.4.Half of POR patients achieve clinical pregnancy at 32 months after active assisted conception treatment with IVF/ICSI-ET,and age and AMH level are independent factors influencing the time to pregnancy（TTP）in POR patients.