抗苗勒氏管激素及卵泡输出率在多囊卵巢综合征患者IVF-ET中的应用研究

发布时间：2018-04-11 18:07

本文选题：抗苗勒氏管激素 + 卵泡输出率　；参考：《桂林医学院》2017年硕士论文

【摘要】：目的:研究多囊卵巢综合征(PCOS)患者COH过程中不同时间点的抗苗勒氏管激素(AMH)水平及卵泡输出率(FORT)对卵巢反应性以及体外受精-胚胎移植(IVF-ET)结局的预测价值。从而指导促排卵用药,以降低OHSS发生率、提高临床妊娠率。方法:选择2015年6月—2016年12月在桂林医学院附属医院生殖医学中心接受体外受精(IVF)-胚胎移植(ET)助孕的PCOS患者90例,另选择同期因输卵管因素接受IVF-ET助孕的患者60例作为对照组。采用酶联免疫吸附法(ELISA)检测AMH水平,比较两组患者AMH水平及各实验室指标。以HCG日16-22mm卵泡数(PFC)及降调后Gn启动前3-8mm窦卵泡数(bAFC)计算PORT值,应用传统FORT阈值分组法[1]将FORT值分为低(42%)、中(42-58%)、高(58%)三组,比较各临床资料的差异。结果:PCOS组的总Gn用量显著高于对照组,差异有统计学意义(P0.05);两组患者的正常受精率、优质胚胎率及临床妊娠率差异均无统计学意义;PCOS组患者妊娠组AMH水平与未妊娠组相比,差异无统计学意义(P0.05)。PCOS组内中等FORT组的正常受精率、优质胚胎率及临床妊娠率均高于另两组,高FORT组的AMH水平显著低于另两组,差异均有统计学意义(P0.05);非PCOS组内高FORT组的正常受精率、优质胚胎率及临床妊娠率均高于另两组,高FORT组的AMH水平显著低于另两组,差异均有统计学意义(P0.05);结论:(1)AMH可以降低卵泡对外源性Gn的反应性,PCOS患者随着AMH水平的升高,促排卵时使用的Gn总量亦增大,由于PCOS患者卵巢高反应性,易导致OHSS的发生,故临床应用时应适当控制Gn的启动剂量,以避免OHSS的发生。(2)血清及卵泡液AMH水平可以预测PCOS患者COH过程中的卵巢反应性,但不能预测PCOS患者的临床妊娠结局。(3)FORT可有效评估PCOS患者COH过程中卵巢对外源性Gn的反应性,且中等FORT组的PCOS患者可获得较好的临床妊娠结局。(4)FORT与AMH水平负相关,两者联合可更好地指导PCOS患者的临床治疗。
[Abstract]:Objective: to study the predictive value of anti-Mullerian tube hormone (AMH) level and follicle output rate (FORT) in patients with polycystic ovary syndrome (PCOS) during COH at different time points for ovarian reactivity and IVF-ETT outcome in vitro fertilization-embryo transfer (IVF-ET).In order to reduce the incidence of OHSS and improve the clinical pregnancy rate.Methods: from June 2015 to December 2016, 90 PCOS patients who received IVFM-ETT in the Center for Reproductive Medicine, affiliated Hospital of Guilin Medical College, were selected.Another 60 patients who received IVF-ET in the same period were selected as the control group.The level of AMH was detected by Elisa, and the AMH level and the laboratory indexes were compared between the two groups.The PORT values were calculated by using 16-22mm follicle number on HCG day and 3-8mm antral follicle number before lowering tone. The FORT value was divided into three groups by traditional FORT threshold grouping method. The difference of clinical data was compared among three groups.Results the total dosage of Gn in the control group was significantly higher than that in the control group (P 0.05). There was no significant difference in the normal fertilization rate, the high quality embryo rate and the clinical pregnancy rate between the two groups.The normal fertilization rate, high quality embryo rate and clinical pregnancy rate in the moderate FORT group were higher than those in the other two groups, and the AMH level in the high FORT group was significantly lower than that in the other two groups.The normal fertilization rate, high embryo rate and clinical pregnancy rate of high FORT group were higher than those of the other two groups, and the AMH level of high FORT group was significantly lower than that of the other two groups.The difference was statistically significant (P 0.05). Conclusion the AMH level of follicles in patients with PCOS can be decreased with the increase of AMH level, and the total amount of Gn used in ovulation induction is also increased. Because of ovarian hyperreactivity in PCOS patients, OHSS may occur easily.In order to avoid the occurrence of OHSS, the serum and follicular fluid AMH levels can predict the ovarian reactivity in the COH process of PCOS patients.However, the clinical pregnancy outcome of PCOS patients could not be predicted, and the response of ovary to exogenous Gn during COH in PCOS patients could be evaluated effectively, and the clinical pregnancy outcome of PCOS patients in moderate FORT group was negatively correlated with the level of AMH.The combination of the two can better guide the clinical treatment of PCOS patients.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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