Serum Anti-mullerian Hormone(2009年會)

試管嬰 兒卵 巢反應 ”新 ” 指標 博元婦產科試 管嬰兒中心 www.babymaker.com.tw

蔡鋒博 *, 陳昭雯 , 張訓銘 , 林招 彰, 張月嬌 , 陳曉青 , 陳俊均 , 潘孟 麗

Serum anti-Müllerian hormone: a novel marker of ovarian responsiveness in IVF cycles Feng-po Tsai, Chao-wen Chen, Hsun-ming Chang,Chao-chang Lin, Hsiao-ching Chen,Yueh-chiao Chang,Chun-chun Chen,Mone-li Peng Poyuan Women Clinic IVF centre

Introduction  Anti-Müllerian hormone (AMH) expression starts in the columnar granulosa cells of primary follicles immediately after differentiation from the flattened pregranulosa cells of primordial follicles. Expression is highest in granulosa cells of preantral and small antral follicles. AMH is no longer expressed during the FSH-dependant final stage of follicle development. Therefore, AMH reflects the number of follicles that have made the transition from the primordial pool into the growing pool, and that is not controlled by gonadotropins. In contrast to FSH, inhibin B and E2, AMH level remain relatively constant during entire menstrual cycle. This characteristic benefits both patients and clinicians.

Material and method  We review 50 IVF patients from December 1, 2007 till July 31, 2008 retrospectively.  The ovarian response was determined by the E2 level on the day of HCG , the number of oocyt yield (mature and immature) and the number of embryos. .

Result  AMH levels showed a positive correlation with number of oocyte yield, immature oocytes, E2 level on the day of HCG injection, and the number of embryo. It also showed a negative correlation with basal serum FSH level. We divided 50 patients into 3 groups based on AMH level : group 1 (AMH <2ng/ml), group2(AMH≧2ng/ml and <4ng/ml)and group 3( AMH≧4ng/ml). A statistics significance was noted between the 3 groups on oocyte yield ( 3.84, 7.56 and 11.1 respectively), E2 level (951.38, 1420.38 and 1558.74 respectively), the number of immature oocyte (0.23, 1.11 and 2.16) and the embryo number (3.0, 5.28 and 7.0).

Fig1: AMH levels showed a positive correlation with number of oocyte yield

y = 1.5185x + 2.2857 R2 = 0.3644

30 20

取卵數

10

線性 (取卵數)

0 0

2

4

6 AMH

8

10

12

.

Fig2: AMH levels showed a negative correlation with basal serum FSH level

18 16 y = -0.3995x + 9.6584 R 2 = 0.0872

day3 FSH

14 12 10

FSH/D3 線性 (FSH/D3)

8 6 4 2 0 0

5

10 AMH

15

Table 1 group :1 (AMH <2ng/ml) N=13

Group:2 (AMH≧2ng/ml and <4ng/ml) N=18

Group:3 (AMH≧4ng/m l) N=19

Number of oocyte yield ±SD

3.84 ±2.87 7.56 ±3.16

11.1 ±7.20

E2 level ±SD

951.38 1420.38 ±654.54 ±498.47 0.23 ±0.42 1.11 ±0.87

1558.74 ±1035.7 6 2.16

number of immature oocyte ±SD embryo number ±SD (pregnancy rate)

±3.64 3.0 ±2.44

5.28 ±3.06

7.0 ±2.0

(46.1%)

(50%)

(42.1%)

Discussion(1)  In this study, we demonstrate that high AMH is associated with higher number of oocyte yield and subsequently embryos available for transfer. This result is consistent with other studies that suggest AMH as a predictor of ovarian response to gonadotropins in cycles of ART (van Rooij et al.,2002,Fanchin et al.,2003,Hazout et al.,2004, Muttukrishna et al., 2004,2005, Penarrubia et al.,2005)  AMH has been shown to not fluctuate across the menstrual cycles (Cook et al.,2000, La Marca et al.,2004,2006), consistent with its role reflecting the continuous, non-cyclic growth of small follicles in the ovary. This characteristic of AMH makes it become a convenient test for patients and clinicians

Discussion(2)  It is important for a clinician to be able to predict both extremes of response who are at risk of ovarian hyperstimulation syndrome and poor responders who are at risk of cycles cancellation. A reliable indicator of ovarian response to stimulation during IVF treatment can be used to modify therapeutic approaches individually.  Due to the limited size of our study, we failed to demonstrate the possible cut-off level of AMH to predict the occurrence of OHSS.

Conclusion  AMH level seems to be a reliable marker to forecast the ovarian response and may help individualization of therapy in IVF treatment.