Correlation Between AMH And Endocrine Metabolic Abnormality And ART Outcomes In PCOS Patients

Objective: To investigate the correlations between serum AMH(anti-mullerian hormone)and endocrine metabolic abnormalities,and the correlations between AHM and IVF/ICSI(vitro fertilization/intracytoplasmic sperm injection)outcomes in PCOS patients during long protocol of ovarian stimulation.Method: The clinical data and endocrine metabolism characteristics of 193 infertile patients with PCOS(PCOS group)and 144 infertile patients with non-PCOS(control group)who underwent IVF/ICSI in our reproductive medical center from September 2015 to December 2016 were retrospectively analyzed.General situations,endocrine metabolism characteristics,IVF outcomes of pregnancy and control ovarian stimulation during long protocol of ovarian stimulation in patients with PCOS and non-PCOS were compared respectively,and the correlations between AMH and the observed indicators above in the two groups were also analyzed respectively.Result: 1.Correlations between AMH and endocrine metabolic abnormalities characteristics with PCOSThere were no significant statistical differences in age,time of infertility,b E2 and b PRL between PCOS group and control group(P>0.05);PCOS group had significant higher level of BMI,AFC,AMH,b LH,b LH/b FSH,and b T than that of control group(P<0.05),and the level of AMH in PCOS group was 2.46 times higher than that of control group;the level of FSH in PCOS group was significantly lower than that of control group(P<0.05).1.1 Correlations between AMH and PCOS endocrine abnormalities(1)The level of AMH in PCOS patients with androgen excess showed a trend of increase,with no significant statistical difference(P>0.05).There was significantly positive correlation between AMH and T in PCOS group(P<0.05),while AMH had no correlation with T in control group(P>0.05).(2)There was no significant statistical difference in AMH of PCOS with high LH and non-high LH(P>0.05);AMH had no correlation with LH in PCOS group and the control group respectively(P>0.05).1.2 Correlations between AMH and PCOS metabolic abnormalities(1)The levels of AMH of obese patients were significantly lower than that of non-obese patients in both PCOS group and control group(P<0.05);AMH showed significantly negative correlations with BMI in both PCOS group and control group(P<0.05).(2)The levels of TG,TC,LDL and APOB in PCOS group were significantly higher than that of the control group(P<0.05);there were no significant statistical differences in AMH between the patients with lipid metabolism disorders and without lipid metabolism disorders in both PCOS group and control group(P>0.05);AMH showed no correlations with lipid metabolic disorders in both PCOS and control group(P>0.05).(3)The levels of AMH of patients with sugar metabolism disorders showed a nonsignificant lower trend in both PCOS group and control group(P > 0.05);AMH showed no correlations with sugar metabolic disorders in both PCOS and control group(P>0.05).(4)There were no significant statistical differences in the levels of AMH between patients with IR and non-IR in both PCOS group and control group(P > 0.05);AMH showed no correlations with HOMA-IR in both PCOS group and control group(P>0.05).2.Correlations between AMH and long protocol ART outcomes in PCOS2.1 Correlations between AMH and long protocol COH outcomesThere were significantly lower levels of Gn dosage,MII oocyte rate and fertilization rate in PCOS group than that of control group(P<0.05);and the number of oocytes,whole embryo freezing rate of PCOS group were significantly higher than that of control group(P<0.05);There were no significant differences in days of Gn stimulation,cleavage rate and high quality embryo rate between PCOS group and control group(P>0.05).In PCOS group,the level of AMH showed positive correlations with the number of oocytes,whole embryo freezing rate;and showed no correlations with Gn dosage,days of Gn stimulation,MII oocyte rate,fertilization rate,cleavage rate and high quality embryo rate.In the control group,the level of AMH showed positive correlations with the number of oocytes,whole embryo freezing rate;and were negatively correlated with Gn dosage,days of Gn stimulation,fertilization rate;and had no correlations with MII oocyte rate,cleavage rate and high quality embryo rate.2.2 Correlations between AMH and pregnancy outcomesMiscarriage rate of PCOS group was significantly higher(P<0.05)and live birth rate was significantly lower(P<0.05)than that of control group.Both implantation rate and clinical pregnancy rate showed a decrease trend in PCOS group(P>0.05).There was no significant difference in ectopic pregnancy rate in PCOS group and control group.AMH showed no correlations with implantation rate,clinical pregnancy rate,abortion rate,ectopic pregnancy rate and live births rate in both PCOS and control group(P>0.05).Conclusion 1.The level of AMH was positively correlated with T in patients with PCOS,was negatively correlated with BMI,and did not show correlations with LH,IR,sugar and lipid metabolic disorders,which speculated that AMH may play a role in PCOS androgen metabolism disorder and may cause the damage of ovarian granulosa cells;2.AMH could reflect the risk of the COH and ovarian reactivity of Gn,which would provide reference for the dosage and improve the safety and efficacy of COH;3.Higher level of AMH in PCOS may have a negative impact on maturity of oocytes and potential of embryo development,which may indicate a higher miscarriage rate and a lower live birth rate.Objective: To investigate the predictive values of AMH for IVF/ICSI outcomes in PCOS patients with different clinical phenotypes.Method: PCOS patients in part 1 were classified into four clinical phenotype groups according to their diagnosis characteristics : group A(classical phenotype): oligo-and/or anovulation(OA)+ hyperandrogeoism(HA)+ polycystic ovary(PCO);group B(non-HA phenotype): OA + PCO;group C(regular menstruation phenotype): HA + PCO;group D(non-PCO phenotype):OA + HA;the correlations between the level of AMH and IVF/ICSI outcomes in PCOS patients with different clinical phenotypes were analyzied respectively.Result:1.Characteristics analysis of different PCOS clinical phenotypes1.1 Comparisons of general condition and endocrinology and metabolism between different PCOS clinical phenotype groups and control groupThere were significant differences in AFC,b FSH,b LH,b LH/b FSH,b T,b E2,BMI,abnormal lipid metabolism rate,sugar metabolism rate and HOMA-IR in the four different PCOS clinical phenotype groups and control group(P<0.01);and there were no significant differences in age,time of infertility,b PRL in the four different PCOS clinical phenotype groups and control group(P>0.05).The classical phenotype showed highest levels of AFC,b LH,b T,BMI,abnormal lipid metabolism rate,whole embryo freezing rate and abortion rate;and showed a lowest level of the live birth rate.1.2 Characteristics of AMH in different phenotypes and correlations between AMH and HA,OA,PCOThe levels of AMH in different PCOS phenotype groups arranged from high to low: A?C?B?D;the level of AMH was positively correlated with PCO and HA,and the correlation of PCO is stronger than HA,while the level of AMH has no correlation with OA.2.Correlations between AMH and long protocol IVF/ICSI outcomes in PCOS with different clinical phenotypes2.1 Comparisons of long protocol IVF/ICSI outcomes among different PCOS phenotypesThere were significant statistical differences in the number of oocytes,MII oocyte rate,fertilization rate,available embryos rate,all embryo freezing rate,clinical pregnancy rate,abortion rate and live birth rate in different PCOS clinical phenotype groups and control group(P<0.05),and no significant differences in cleavage rate,embryo rate,implantation rate and ectopic pregnancy rates(P>0.05).2.2 Correlations between AMH and long protocol IVF/ICSI outcomes in PCOS with different clinical phenotypes(1)phenotype A(classical phenotype,OA+HA+PCO): the level of AMH was positively correlated with the number of oocytes,high quality embryo rate,whole embryo freezing rate,implantation rate,and clinical pregnancy rate;and it showed no correlations with MII oocyte rate,fertilization rate,cleavage rate,miscarriage rate,ectopic pregnancy rate and live birth rate.(2)phenotype B(non-HA phenotype,OA+PCO): the level of AMH showed no correlations with all observed indicators.(3)phenotype C(regular menstruation phenotype,HA+PCO): the level of AMH was positively correlated with number of oocytes and whole embryo freezing rate;was negatively correlated with available embryo rate;and it showed no correlations with other observed indicators.(4)phenotype D(non-PCO phenotype,OA + HA): AMH showed no correlations with all observed indicators.Conclusion 1.The classical phenotype had the the most severe illness and the worst pregnancy outcomes;non-HA phenotype had the slightest clinical manifestations and a high level of LH,which might be its pathogenesis that different from other phenotypes of PCOS.2.The levels of AMH in different clinical phenotypes of PCOS arranged from high to low: classical?regular menstruation?non-HA?non-PCO;influence on AMH of PCO was stronger than T,while AMH had no correlation with OA.3.AMH had different predictive values in PCOS with different clinical phenotypes: AMH might play a predictive role in classical phenotype and regular menstruation phenotype;while in non-HA and non-PCO phenotype,AMH was not of great predictive value.