AMH水平升高与超促排卵药物反应减弱有关吗？

OBJECTIVE

目 的

Studies have suggested an association between elevated AMH levels and decreased response to ovulation induction agents in infertile patient with PCOS regardless of agent used. Several theories have been postulated to be responsible for the mechanism behind this inverse relationship, including AMH-mediated inhibition of aromatase activity, as well as reduction in expression of the FSH receptor mRNA. The objective of this study is to determine whether this association exists not only in patients with PCOS but also patients with elevated AMH levels who do not meet criteria for PCOS.

研究表明，即便使用不同的药物，AMH异常升高与不孕症患者（尤其是多囊卵巢综合征患者）对排卵诱导剂反应减弱之间存在一定的联系。已有几种理论试图解释这种负相关关系的机制，包括AMH介导的芳香化酶活性抑制，以及FSH受体mRNA表达的降低。本研究旨在确定这种关联是否不仅存在于多囊卵巢综合征患者，还包括那些AMH水平升高但不符合多囊卵巢综合征诊断标准的患者。

MATERIALS AND METHODS

材料与方法

This is a retrospective cohort study of 831 patients with infertility between the ages of 19 and 42, who had documented AMH levels and underwent OI cycles with either letrozole or clomiphene citrate at a single academic center between December 2019 and August 2022. Patients were classified as having PCOS or not using Rotterdam criteria. AMH was treated as a continuous variable. The primary outcome for each cycle was response to ovulation induction which was defined as follicular growth of at least one follicle to at least 17mm. Response to treatment based on AMH levels was analyzed using logistic regression with a p-value of <0.05 defining significance. Models were adjusted for both age and BMI and controlled for the potential of more than one cycle per woman.

本研究为回顾性队列研究，对象为831名年龄在19至42岁之间的不孕症患者，这些患者在2019年12月至2022年8月期间，在某一研究中心进行了有记录的AMH水平测试，并接受了来曲唑或克罗米芬诱导排卵治疗。采用鹿特丹标准将患者分为PCOS或非PCOS。AMH作为连续变量。每个周期的主要结果是对促排药物的反应，其定义为至少一个卵泡生长到至少17mm。治疗反应基于AMH水平采用逻辑回归分析，p<0.05有显著性。模型在调整年龄和体重指数（BMI）的同时，控制了每位女性可能经历多个周期的潜在影响。

RESULTS

结 果

1531 OI cycles were included in the analysis. Mean AMH for patients with PCOS was 9.2 ng/mL(range was 0.6 to 42), and for non-PCOS was 3.16 ng/mL (range was 0.015 to 24). In both PCOS and non-PCOS patients, AMH levels were lower in patients who achieved an initial follicular response when compared to those who did not ([PCOS: 5.42 vs 8.63], [nonPCOS: 6.44 vs 7,62] for each, p=.0002) in both the letrozole and clomiphene citrate treatment groups. Furthermore, each ng/mL increase in AMH level was associated with lower odds of ovulation after adjustment for both age and BMI (OR 0.93 (CI: 0.90-0.96) vs. 0.76 (CI: 0.66-0.88) for PCOS vs. PCOS).

共纳入1531个诱导排卵周期进行分析。PCOS患者的平均AMH水平为9.2ng/ml（0.6-42），非PCOS患者则为3.16ng/ml（0.015-24）。所有PCOS患者和非PCOS患者中，在来曲唑或克罗米芬促排治疗组中获得最初卵泡反应的患者比没有获得的患者AMH水平更低（[PCOS:5.42 vs 8.63][非PCOS:6.44 vs 7.62],p=0.0002）。此外，在调整年龄和BMI后，AMH水平每升高一个单位都与排卵几率下降有关(OR0.93(CI:0.9-0.96) vs 0.76(CI:0.66-0.88),PCOS vs非PCOS)。

CONCLUSIONS

结 论

Higher AMH levels are associated with lower likelihood of response to ovulation induction regardless of ovulation induction agent used. This relationship is seen in patients with both PCOS and patients without PCOS.

无论使用哪种促排卵药物，较高的AMH水平与促排卵反应可能相关。这种关联在PCOS和非PCOS患者中均存在。

IMPACT STATEMENT

影响陈述

AMH levels are higher in women who do not respond to oral ovulation induction agents, a relationship that appears to be independent of infertility diagnosis.

AMH水平在对口服促排卵药物无反应的女性中更高。这一关系似乎与不孕症的诊断无关。

文章来源：

ELEVATED AMH LEVELS ARE ASSOCIATED WITH LOWER LIKELIHOOD OF RESPONSE TO OVULATION INDUCTION AGENTS IN INFERTILE WOMEN Kuyoro, Olutunmike et al.Fertility and Sterility, Volume 120, Issue 4, e231 - e232