The Study Of The Predictive Value Of AMH In Short Effect Long Scheme IVF-ET On Ovarian Hyperresponsiveness

Purpose The study compared the predictive value of the serum AMH level in the menstrual period,after the downfall and the trigger day and the E₂ level of the trigger day to the short effect long scheme IVF/ICSI-ET,and obtained the corresponding value of the cut-off point,in order to use the AMH level to guide the clinical super platoon medication scheme,reduce the incidence of OHSS and improve the auxiliary reproductive outcome.Method A prospective analysis of 92 infertile women with short effect long scheme IVF/ICSI-ET in the reproductive center of First Hospital Affiliated to Soochow University from January to June of 2017.According to the number of sinus oocytes?AFC?,the patients were divided into the normal reaction group?3<unilateral AFC<10?and the high response group?unilateral AFC>10?.The serum AMH levels were measured in three periods of menstrual period,after the downfall and the trigger day respectively.By comparing and analyzing the AMH levels of the two groups at different period of treatment,the amount of Gn and the number of Gn days,and the number of acquired eggs,the number of 2PN,the rate of fertilization,the number of embryos available,the available embryo rate,the number of embryos available,the rate of excellent embryos at third days,the rate of optimal embryo,the rate of OHSS,the cancellation rate of the transplantation cycle,the rate of fresh cycle transplantation,the rate of ET clinical pregnancy were compared.The ROC curve was used to analyze the predictive value of the AMH and the E₂ level of the trigger day on the ovarian hyper response and to obtain the corresponding cut-off points.Result The number of acquired eggs,the number of 2PN and the number of available embryos in the high reaction group were higher than those in the normal reaction group,and the rate of optimal embryo was lower than that in the normal reaction group,and the difference was statistically significant?P<0.05?.The incidence of OHSS in the high response group was significantly higher than that in the normal reaction group?P<0.01?.The level of AMH in the high reaction group was higher than that of the normal reaction group in the menstrual period,after the downfall and the trigger day,the difference was statistically significant?P<0.05?,and the level of AMH on the trigger day in the high reaction group was significantly higher than that of the menstrual period?P<0.01?,compared with the normal reaction group.The size of the ROC curve for predicting the hyperreaction of the ovary:the level of AMH in the menstrual period?0.81?>the AMH drop level of the trigger day compared with the menstrual period?0.77?>the AMH level of the trigger day?0.74?>the E₂ level of the trigger day?0.71?>the AMH level after the downfall?0.69?.The cut-off value of the AMH in the menstrual period obtained by ROC curve was 5.67 ng/ml,the cut-off value of the AMH drop level of the trigger day compared with the menstrual period was 3.42ng/ml,the cut-off value of the trigger day AMH was1.39 ng/ml,the cut-off value of the trigger day E₂ was 4.41,the cut-off value of AMH after the downfall was 4.41 ng/ml.Through Spearman correlation analysis,there was a negative correlation between menstrual period AMH/AMH after the downfall and Gn dosage,and the correlation coefficient R was-0.4 and-0.28 respectively.The correlation coefficient R of AMH in different periods and the number of acquired eggs was:AMH after the downfall?0.44?>AMH during the menstrual period?0.41?>the AMH drop level of the trigger day compared with the menstrual period?0.35?>AMH on the trigger day?0.24?;the correlation coefficient R of E₂ on trigger day and AMH on trigger day was 0.52,P<0.01.Conclusion In the short effect long scheme IVF/ICSI-ET,the AMH level at different time points varied dynamically with the natural menstrual cycle.This study found that when the AMH value of the menstrual period is more than 5.67 ng/ml,the AMH value after the downfall is more than 4.41 ng/ml,the AMH value of the trigger day is more than 1.39ng/ml,The AMH drop level of the trigger day from the period of menstruation is more than 3.42ng/ml,and the trigger day E₂ value is more than 4431pg/ml,the incidence of ovarian hyperresponsiveness increased.It is suggested that the monitoring of serum AMH level in the period of menstruation,after the downfall,and on the trigger day is beneficial to the prejudgement of ovarian hyperresponsiveness and the adjustment of the amount of Gn to reduce the occurrence of ovarian hyperstimulation.