Association Study Of AMH Applying In Modified Long-acting Gnrh Agonist Prolonged Protocol In Follicular Phase And Long GnRH Agonist Protocol

Objective:Evaluating the prognostic ability of AMH for predicting ovarian response to controlled ovarian stimulation using modified long-acting GnRH agonist prolonged protocol in follicular phase and long GnRH agonist protocol. And determining the cut-off values of AMH for prediction of poor and excessive response.Methods:This retrospective analysis included 130 women who underwent IVF/ICSI-ET,they were divided into two groups according to stimulation protocol, with the modified long-acting GnRH agonist prolonged protocol in follicular phase (group A,n=63) and long GnRH agonist protocol (group B,n=67),comparing the clinical outcomes of the two groups. Analysing the correlation between AMH and age、AFC、basal FSH level、basal LH level、basal E2 level、basal T level、the duration of Gn、total Gn dosage、the LH、E2、P level of HCG administration day、the number of oocytes retrieved and high quality embryos、fertilization rate、 high quality embryos rate. Poor response were defined as less than 5 oocytes were retrieved, and excessive response were defined as greater than 19 oocytes were retrieved. Evaluating the prognostic ability of AMH for predicting poor and excessive response. According to whether they got pregnancy,the transplanted patients were divided into two groups,the pregnant group and non pregnant group, analyzing the prognostic ability of AMH for predicting pregnancy.Results:1.The duration of Gn、total Gn dosage、the LH、E2、P level and endometrial thickness of HCG administration day、the number of oocytes retrieved and high quality embryos、 fertilization rate、high quality embryos rate、implanting rate and clinical pregnancy rate were not statistically significantly different in group A and group B(P>0.05).2.AMH level correlated negatively with age、basal FSH level and total Gn dosage, and positively with basal LH and T level、 the E2 level of HCG administration day、the number of oocytes retrieved and high quality embryos. There were no correlation with AMH level and basal E2 level、the duration of Gn、the LH、P level of HCG administration day、fertilization rate、high quality embryos rate.3.The area under the receiver operating characteristic curves of AMH level predicting poor and excessive response is 0.850 and 0.796,all better than AFC and basal FSH level. The best threshold for predicting a poor response was found to be 1.89 ng/ml with a sensitivity of 90% and a specificity of 79%.For the prediction of excessive response, the threshold was set at 3.51ng/ml,which resulted in a sensitivity of 70%, a specificity of 77.5%. And the predictive ability of AMH for ovarian response was not affected by the ovarian stimulation protocols.4.The age was lower and high quality embryos rate was higher in the pregnant group.5、AMH level did not show significant predictive value of pregnancy.Conclusions:1.There were no significant difference of IVF outcomes between modified long-acting GnRH agonist prolonged protocol in follicular phase and long GnRH agonist protocol.2.AMH level can serve as a good predictor of ovarian response, however, AMH level may not be a valuable predictor for clinical pregnancy.3. The prognostic ability of AMH for predicting ovarian response is better than AFC、basal FSH level.