The Role Of Serum And Follicular Fluid AMH In IVF-ET

Objective:A certain number of patients were selected, the implementation of in vitro fertilization- embryo transfer(IVF-ET), all patients, anti-Mullerian hormone(AMH), sex hormone levels of all patients were tested in fasting state on 3rd day of menstruation,HCG day and oocyte retrieval day, and bilateral ovarian follicles were measured by transvaginal ultrasound. On the day of oocyte retrieval serum AMH, sex hormone levels again, and take measured AMH levels in follicular fluid. By contrast, the analysis of the 3rd days, HCG Day, oocyte retrieval day AMH, menstrual hormones were compared between patients and the number of follicles, while the number of patients in each group of oocytes, cleavage rate, embryo quality and pregnancy rates of conduct comparison, and thus a clear relationship with these indicators AMH explore the relationship between AMH and IVF-ET pregnancy outcome, evaluation of their role in the process of IVF-ET and predictive value for clinical outcomes, as clinical monitoring, assessment and intervention theory for infertility treatment has opened a better way. Method:1、81 patients were select from in Taian Central Hospital November who come to the hospital between 2012 to December 2013 that accept IVF-ET, uses gonadotropin releasing hormone agonist(Gn RH-a) long line of pituitary down-regulation program, according to patients hyperstimulation of the reaction, the patients were divided into low ovarian response group, normal ovaries and ovarian response group highly reactive groups.2、All patients in the first three days of menstruation and the day of fasting serum HCG hormone and AMH, and the number of antral follicles in the ovaries was measured by transvaginal ultrasound. Oocyte retrieval and transplantation day in day again measured serum AMH and sex hormone levels and measured AMH levels in follicular fluid oocyte retrieval date, the difference between groups these indicators.3、Patients in each group its first three days of menstruation, HCG Day, oocyte retrieval day AMH, differences in sex hormones and differences in the number of follicles.4、Comparing the group of patients who oocytes, cleavage rate, embryo quality and differences in pregnancy rates, clearly AMH relationship with the indicators mentioned above. Results:1、By comparing the three groups of patients on the third day of menstruation-related indicators can be found that age, AFC, FSH, AMH and the number of oocytes, fertilized, and the number of embryos available, the total number of embryos have a statistically significant difference(P<0.05), LH, E2, T, TSH and cleavage rate comparison, the difference was not statistically significant(P>0.05). And among the three groups, AMH, and fertilized oocytes, embryos between the groups and the total number of available embryos have statistical significance(P <0.05), each indicator has a low response group < normal response group < high responders.2、Three groups of patients HCG days after discovery-related indicators, AMH, E2, P and FSH values were statistically significant(P <0.05), LH relatively no statistical significance(P> 0.05). And three groups AMH, E2 and FSH among groups were statistically significant(P <0.05), which also has a low reactivity of each index group < normal response group < highly reactive groups.3、COH day three groups of patients with relevant indicators found in serum and follicular fluid AMH, E2 and P number were statistically differences(P <0.05). And among the three groups in serum and follicular fluid AMH, E2 and P in each group also were statistically significance(P <0.05), the indicators also have low response group < normal response group < highly reactive groups.4、Three groups of patients transplanted date related indicators found that serum AMH, E2 were statistically differences(P <0.05). Between and among the three groups of serum AMH and E2 each group has statistical significance(P <0.05), the indicators also have low response group < normal response group < highly reactive groups.5、menstrual different reactive groups of patients on the third day and the day of HCG, oocyte retrieval day and day of serum AMH levels and transplanted follicular fluid AMH levels there are differences, the indicators also have low response group <normal response group <highly reactive group.6、number of oocytes and AFC, HCG Day E2, oocyte retrieval day E2, transplant day E2, HCG Day P, oocyte retrieval day P, P transplant day were positively correlated; And with age, day 3 FSH, HCG Day FSH negative correlation. Conclusion:1、The level of serum and follicular fluid AMH, AFC and FSH levels were part of the evaluation indicators of ovarian reserve. At the same time in the process of IVF-ET, they are better predict ovarian response markers.2、The level of serum AMH can only predict ovarian response, but can not effectively predict pregnancy outcome. The level and pregnancy outcome AMH levels in follicular fluid is a certain degree of correlation, so this study suggests that the level of follicular fluid AMH to predict pregnancy outcome is an indicator, but still need to conduct further clinical validation.3、 Serum AMH of the earlier and more sensitive than the basic FSH, predicting ovarian reserve is a certain clinical value, and to provide guidance for the specific part of the development of ovulation induction program.4、 OHSS occurs and ovarian ovulation drugs for high reactive state are closely related. Based AMH, HCG and HCG day AMH E2 levels for predicting the occurrence of OHSS is a certain guiding significance. Timely adjustment programs of medication depending on the situation, thereby reducing the risk of OHSS occurred.5、Individual indicators to assess ovarian reserve the limitations and shortcomings, however, the combination of a number of indicators for the assessment of ovarian reserve will be more accurate.