Meta Analysis Of The Predictive Significance Of AMH On The Outcome Of Assisted Pregnancy In Patients With Polycystic Ovary Syndrome

Objective: This study aims to explore the predictive significance of AMH on assisted reproductive outcomes in patients with polycystic ovary syndrome(PCOS)by using meta-analysis to demonstrate the impact of different serum levels of anti Mullerian hormone(AMH)on assisted reproductive outcomes in patients with PCOS.To provide scientific reference for the application of AMH in assisted reproduction,the formulation of individualized programs,and the prevention of Ovarian Hyper Stimulation Syndrome(OHSS)and to provide new solutions to common clinical problems.Method:Retrieve all publicly published Chinese and English literature on PCOS,AMH,and assisted reproduction from October 2017 to October 2022,including the Chinese Journal Full Text Database(CNKI),Wanfang Data Medical Information System(WF),Vip Chinese Science and Technology Journal Database(VIP),Pubmed,and Web of Science databases.The author and another evaluator screened and evaluated the quality of the obtained literature,extracted and entered literature information,extracted outcome indicators such as the number of oocytes obtained,the number of high-quality embryos,the number of transferred embryos,the clinical pregnancy rate,the live birth rate,the abortion rate,and the incidence of ovarian hyperstimulation syndrome.The results were analyzed using Revman 5.4 and Stata 12.0software.Result:A total of 19 clinical studies were included in this study,including 11 Chinese literature and 8 English literature.The included literature has a NOS score of 6-8,which is a high-quality study.Meta analysis results:1.Number of eggs captured: defined as a low AMH group with serum AMH ≤ 8-12ng/ml,and a high AMH group with serum AMH>8-12ng/ml.The number of eggs captured in the low AMH group was significantly lower than that in the high AMH group,with a combined effect of-2.97 and a 95% CI of(-4.17,-1.77),P<0.05.Sensitivity analysis showed that there were no studies that had a significant impact on heterogeneity.2.Number of high-quality embryos and number of transferred embryos: define serum AMH ≤ 10ng/ml as a low AMH group,and serum AMH>10ng/ml as a high AMH group.There was no significant correlation between serum AMH levels and the number of high-quality embryos and transferred embryos in assisted pregnancy patients.The combined effect amount and 95% CI were-0.29(-0.75,0.17)and 0.04(-0.06,0.14),respectively,P>0.05.The sensitivity analysis of high-quality embryo numbers showed that there were no studies that had a significant impact on heterogeneity.Sensitivity analysis of transplanted embryo numbers showed that one of the studies may be the source of heterogeneity,and after exclusion,heterogeneity decreased significantly compared to before.3.Clinical pregnancy rate: defined as low AMH group with serum AMH ≤ 9-13ng/ml,and high AMH group with serum AMH>9-13ng/ml.There was no significant correlation between serum AMH level and clinical pregnancy rate in assisted pregnancy patients.The combined odds ratio(OR)and 95% CI were 0.94(0.67,1.33),P>0.05.Sensitivity analysis showed that there were no studies that had a significant impact on heterogeneity.4.Live production rate: defined as a low AMH group with serum AMH ≤ 10-12ng/ml,and a high AMH group with serum AMH>10-12ng/ml.The survival rate in the low AMH group was significantly lower than that in the high AMH group,with a combined odds ratio(OR)and 95% CI of 0.86(0.76,0.98),P<0.05.5.Abortion rate: defined as low AMH group with serum AMH ≤ 10-12ng/ml,and high AMH group with serum AMH>10-12ng/ml.There was no significant correlation between serum AMH level and abortion rate in assisted pregnancy patients.The combined odds ratio(OR)and 95% CI were 1.05(0.83,1.33),P>0.05.6.High risk cycle cancellation rate of OHSS and incidence of moderate to severe OHSS:defined as low AMH group with serum AMH ≤ 10ng/ml,and high AMH group with serum AMH>10ng/ml.The high risk cycle cancellation rate and the incidence of moderate to severe OHSS in the low AMH group were lower than those in the high AMH group.The combined odds ratio(OR)and 95% CI were 0.36(0.27,0.48),0.38(0.27,0.55),P<0.05.7.Other outcome indicators: There was no significant correlation between serum AMH values and the fertilization rate,premature delivery rate,multiple pregnancy rate,and incidence of ovarian hyperresponsiveness in PCOS patients undergoing assisted reproduction,while the ovulation rate in the low AMH group was higher than that in the high AMH group.Conclusion: The serum AMH value of PCOS patients undergoing assisted reproduction was positively correlated with the number of oocytes retrieved,the live birth rate,the high-risk cycle cancellation rate of OHSS,and the incidence of moderate to severe OHSS,while negatively correlated with the ovulation rate.It was not significantly correlated with the number of high-quality embryos,the number of transferred embryos,clinical pregnancy rate,abortion rate,fertilization rate,preterm birth rate,multiple pregnancy rate,and the incidence of ovarian hyperresponsiveness.AMH can effectively guide the formulation of individualized programs,helping to detect and prevent related complications in a timely manner.Therefore,during assisted reproduction,it is necessary to correctly interpret and understand AMH values in different situations,so as to achieve greater effectiveness in clinical treatment.