抗苗勒氏管激素在多囊卵巢综合征患者控制性卵巢刺激过程中的变化及与IVF-ET结局的关系

发布时间：2018-01-17 03:11

本文关键词：抗苗勒氏管激素在多囊卵巢综合征患者控制性卵巢刺激过程中的变化及与IVF-ET结局的关系　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：研究血清抗苗勒氏管激素（AMH）在多囊卵巢综合征（PCOS）患者控制性卵巢刺激（COS）过程中的变化；分析血清基础AMH水平与COS过程中促性腺激素（Gn）剂量的关系；探讨血清和卵泡液中AMH水平与体外受精-胚胎移植(IVF-ET)结局的关系及血清AMH水平对卵巢过度刺激综合征(OHSS)的预测价值。方法：选取2012.12～2013.10于河北医科大学第二医院生殖中心因输卵管因素和/或男方因素接受IVF/ICSI-ET助孕的患者为研究对象，其中包括PCOS患者共70例（试验组），，非PCOS患者共20例（对照组）。所有研究对象分别于月经周期的第3天（Day3）、垂体降调节后即启动外源性促性腺激素日(Gn日)、注射绒毛膜促性腺激素日（HCG日）收集血清，取卵日(OPU日)清晨收集卵泡液。比较两组患者Day3、Gn日、HCG日血清AMH水平、OPU日卵泡液AMH水平，记录每位患者的基础卵泡刺激素（FSH）水平、Gn的用量、COS天数、获卵数、可移植胚胎数、临床妊娠情况以及中重度OHSS的发生情况。按照Day3的血清AMH水平将PCOS患者分为低AMH组、中AMH组和高AMH组，比较三组的基础FSH水平、Gn的用量、COS天数、获卵数、可移植胚胎数、妊娠率以及中重度OHSS的发生情况。分析PCOS组的血清AMH(Day3、Gn日及HCG日)以及卵泡液AMH水平与中重度OHSS的关系。结果：PCOS组Day3、Gn日、HCG日血清AMH以及OPU日卵泡液中AMH均高于对照组，差异有统计学意义（P0.05）；两组患者Gn日的血清AMH水平均较Day3水平升高，差异有统计学意义（P0.05）;HCG日血清AMH水平较Day3水平降低，差异有统计学意义（P0.05）。PCOS组Gn的用量高于对照组，差异有统计学意义（P0.05），PCOS组与对照组的COS天数、可移植胚胎数、妊娠率、中重度OHSS发生率均无统计学差异（P0.05）。PCOS组中高AMH组的Gn用量高于低AMH组及中AMH组，但低AMH组与中AMH组相比Gn用量无统计学差异（P0.05），高AMH组与低AMH组及中AMH组比Gn用量均有统计学差异（P0.05）。对照组中妊娠患者与未妊娠患者相比血清与卵泡液中的AMH水平显著增高，差异均有统计学意义（P0.05）。在PCOS患者中妊娠组与未妊娠组相比血清以及卵泡液中的AMH水平均无统计学差异（P0.05）。PCOS组中中重度OHSS患者Day3、Gn日、HCG日AMH水平以及卵泡液中的AMH水平与未发生OHSS患者比均无统计学差异（P0.05），但发生中重度OHSS患者HCG日血清AMH较Day3的下降水平比未发生者升高，差异有统计学意义（P0.05）。结论：血清AMH水平在进行COS的过程中有显著变化：血清AMH水平经过垂体降调节后升高，经过Gn促排卵后降低；基础AMH水平较高的PCOS患者进行控制性超排卵的过程中需要的Gn剂量增加；血清及卵泡液AMH水平能预测非PCOS患者的妊娠结局；血清HCG日AMH水平较Day3的下降水平可以用于预测PCOS患者中重度OHSS的发生。
[Abstract]:Objective: to study the changes of serum anti-Mullerian tube hormone (AMH) in patients with polycystic ovary syndrome (PCOS) treated with controlled ovarian stimulation (COSs). The relationship between serum basal AMH level and gonadotropin Gnn dose during COS was analyzed. To investigate the relationship between the levels of AMH in serum and follicular fluid and the outcome of IVF-ETS and the predictive value of serum AMH level in ovarian hyperstimulation syndrome (OHSS). Methods:. The patients who received IVF/ICSI-ET for pregnancy in the reproductive center of the second Hospital of Hebei Medical University on February 12, 2013.10 were selected as the study subjects because of fallopian tube factors and / or male factors. These included 70 patients with PCOS (trial group, 20 patients without PCOS) (control group, all subjects were studied on the 3rd day of menstrual cycle). The serum was collected immediately after hypophysis regulation and HCG was injected into the human chorionic gonadotropin (HCG). Follicular fluid was collected early in the morning. The serum AMH level was compared between the two groups on the day of Day3 Gn and the level of AMH in the follicular fluid on the day of OPU. The basal follicle stimulating hormone (FSH) level of each patient was recorded. The number of days of COS, the number of eggs obtained and the number of embryos transfered were recorded. According to the serum AMH level of Day3, PCOS patients were divided into low AMH group, middle AMH group and high AMH group. The number of days, the number of eggs and the number of embryos transfered were compared among the three groups. The pregnancy rate and the occurrence of moderate and severe OHSS were analyzed in PCOS group. The relationship between AMH level in follicular fluid and moderate to severe OHSS was analyzed. Results the levels of AMH in serum and AMH in follicular fluid on OPU day in the control group were significantly higher than those in the control group (P 0.05). The serum AMH level of the two groups was higher than that of Day3 on the day of Gn, and the difference was statistically significant (P 0.05). The level of serum AMH in HCG group was lower than that in Day3 group, the difference was statistically significant (P 0.05). The dosage of Gn in PCOS group was higher than that in control group, and the difference was statistically significant (P 0.05). Days of COS, number of embryos transferable and pregnancy rate in PCOS group and control group. There was no significant difference in the incidence of moderate and severe OHSS. The dosage of Gn in high AMH group was higher than that in low AMH group and moderate AMH group. However, there was no significant difference in the dosage of Gn between the low AMH group and the middle AMH group (P0.05). There was significant difference in the dosage of Gn between high AMH group, low AMH group and middle AMH group (P0.05). The levels of AMH in serum and follicular fluid in the control group were significantly higher than those in the non-pregnant group. There was no significant difference in AMH levels in serum and follicular fluid between pregnant group and non-pregnant group in PCOS patients (P 0.05). Day3 in moderate and severe OHSS patients in PCOS group. There was no significant difference in the level of AMH and the level of AMH in follicular fluid between patients with OHSS and those without OHSS (P 0.05). However, the level of serum AMH in patients with moderate and severe OHSS on the day of HCG was higher than that in patients without Day3, and the difference was statistically significant (P 0.05). Conclusion: the level of serum AMH has a significant change in the process of COS: the level of serum AMH increases after hypophyseal regulation and decreases after gonadovulatory stimulation. The Gn dose needed by PCOS patients with higher basal AMH level was increased during the process of controlled hyperovulation. AMH levels in serum and follicular fluid can predict pregnancy outcome in non-#en1# patients. The decrease of serum HCG day AMH level compared with Day3 level can be used to predict the occurrence of moderate and severe OHSS in PCOS patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.75

【引证文献】