The Predictive Value Of Serum AMH In The Diagnosis Of PCOS And The Clinical Outcome Of IVF-ET In Patients With PCOS

Part 1 The value of serum Anti-Miillerian hormone in the diagnosis of polycystic ovary syndromeObjective:We aimed to evaluate the advantage of Anti-Mullerian hormone(AMH)32 in the diagnosis of polycystic ovary syndrome(PCOS).Methods:The study was approved by the Ethics Committee of Hangzhou Obstetrics and Gynecology Hospital and informed consent was obtained.The clinical and laboratory data of 56 PCOS patients and 52 normal women with menstrual cycle(26-35 days)who were admitted to the outpatient department of Hangzhou Obstetrics and Gynecology Hospital from January 2016 to July 2016 were reviewed.Firstly,women included were divided into PCOS group and control group,the differences of clinical and laboratory indicators between the two groups were analyzed.Secondly,the correlation between serum AMH levels and the remaining indicators between the two groups was analyzed.Lastly,receiver operating characteristic(ROC)curves were generated to assess the utility of AMH,AFC,the luteinizing hormone/follicle stimulating hormone(LH/FSH)ratio and testosterone(T)to discriminate between the PCOS and control groups.Results:A total of 108 patients were included in the study,they were divided into PCOS group and control group.Compared with the control group,the PCOS group had significantly higher BMI,T,HOMA-IR,Glu,TG levels and serum AMH,LH/FSH ratio,AFC.The differences were statistically significant(p<0.05).No differences were found for serum total cholesterol(TC),high-density lipoprotein cholesterol(HDLC)or low-density lipoprotein cholesterol(LDLC)between the two groups.General linear regression models were used to analyze the associations between the serum AMH level and other clinical parameters in both the PCOS and control groups.There were no correlations between variables such as age and serum Glu,TG,TC,LDLC and AMH levels in the two groups.Serum HDLC levels and HOMA-IR and AFC were positively associated with serum AMH level(r:0.356,0.317,and 0.533,respectively,p<0.05),and BMI was negatively associated with serum AMH in patients with PCOS(r:-0.320,p<0.05).The serum HDLC level and AFC were also positively correlated,while the serum HOMA-IR was negatively correlated with the serum AMH level in the control group(r:0.317,0.632,and-0.345,respectively,p<0.05).The AUCs for serum AMH,AFC,LH/FSH ratio and T significantly discriminated between the control and PCOS groups according to four clinical measurements.The highest AUC value was for AMH(AUC=0.952,p<0.001),which was followed by the AFC(AUC=0.778,p<0.001)and LH/FSH ratio(AUC=0.760,p<0.001).The lowest was for testosterone(AUC=0.665,p=0.003)in the analysis of the control and PCOS groups.As shown for AMH,a cut-off value of 6.09 ng/ml was the best critical point,with a diagnostic sensitivity of 88%,specificity of 88%and PPV of 89%.Conversely,diagnostic exclusion of PCOS was shown by AMH<6.09 ng/ml giving 87%NPVConclusion:The serum AMH level shows a better specificity and sensitivity than other clinical indicators at diagnosing PCOS.AMH is considered as a novel,non-invasive predictor of PCOS diagnosis in Chinese PCOS women.When the AMH is 6.09 ng/ml,it achieves the optimal combination of sensitivity and specificity,which are both 88%.Part 2 The predictive value of serum AMH in clinical outcome of IVF-ET in patients with PCOSObjective:Analyze the clinical data of PCOS patients undergoing in vitro fertilization and embryo transfer(IVF-ET),to explore the influencing factors of in vitro fertilization outcomes,evaluate whether serum basal AMH has predictive value,In order to provide a scientific basis for clinical diagnosis and treatment.Methods:This study included PCOS patients who undergoing IVF-ET treatment after the control of superovulation in the Reproductive Medicine Center of Lishui People's Hospital from January 2016 to June 2018.According to the in vitro fertilization outcomes,patients included were divided into non-clinical pregnancy group and the clinical pregnancy group.Then the differences of factors affecting clinical pregnancy outcomes between the two groups were compared.Results:In the study,a total of 23(54.76%)clinical pregnancies were observed in 42 PCOS women.There were 4 patients with biochemical pregnancy,and biochemical pregnancy rate was 9.52%.According to whether clinical pregnancy or not,patients were divided into the non-pregnancy group and the clinical pregnancy group.Differences in the means of two groups were compared using Student's t-test,and the medians of two groups were compared by the Mann-Whitney U test after considering the variance and distribution.Patients in the clinical pregnancy group had more numbers of embryo transfer(p<0.05).There was no statistical difference in female age,male age,infertile time,female BMI,basic endocrine hormone levels,AFC,number of eggs,number of fertilized eggs,cleavage number,number of good quality embryo,Gonadotropins(Gn)using duration and Gn quantity.Conclusion:For PCOS patients,serum basal AMH is not suitable as a predictor of clinical pregnancy outcome after in vitro fertilization.