Study On The Relationship Between The Level Of AMH And The Loss Of Early Pregnancy After In Vitro Fertilization

Objective: Studies have shown that anti-Mullerian hormone(AMH)levels can evaluate the number of antral follicles and predict live birth.However,few studies have analyzed the relationship between AMH and early pregnancy loss rate after in vitro fertilization and embryo transfer(IVF-ET),in order to further explore the relationship between AMH and embryo quality.This study will analyze the relationship between AMH level and early pregnancy loss in patients with IVF-ET to determine the effect of AMH level on embryo quality and egg quality.Methods: The subjects were women aged 20-49 years old who underwent the first cycle of in vitro fertilization and fresh embryo transfer in the Reproductive Medicine Center of the Affiliated Hospital of Jining Medical College.The collected indicators are: age,body mass index,type of infertility,years of infertility,follicle stimulating hormone,luteinizing hormone,estradiol,prolactin,testosterone,total antral follicle count,thickness of intima on the day of transfer,egg recovery rate,number of eggs obtained,total use of gonadotropin,total days of gonadotropin use,number of high-quality embryos obtained,number of available embryos obtained,Related data on the number of transplanted embryos and clinical pregnancy status.The clinical data of 607 women who underwent the first cycle of IVF fresh embryo transfer in our center from January2018 to January 2020 were analyzed retrospectively.According to the level of AMH,the patients were divided into high AMH group(≥1.1ng/ml)and low AMH group(< 1.1 ng/ml).Continuous variables are expressed by mean ±standard deviation,and subtyped variables are expressed by the number of cases or percentage.First of all,the general data of the study population were collected and compared by using the description of the study population,and then the univariate correlation analysis model was used to analyze the correlation between the level of AMH and other related variables and the pregnancy outcome of early pregnancy loss.Then,after adjusting for possible confounding factors,we further used multiple regression models to test whether AMH levels were independently associated with early pregnancy loss.Finally,we use smooth curve fitting to intuitively understand the relationship between the level of AMH and the pregnancy outcome of early pregnancy loss,and then analyze the threshold effect to fully prove whether there is an obvious relationship between the two.Results: The results showed that compared with the high AMH group,the low AMH group showed lower antral follicle count(AFC),higher basal follicle stimulating hormone(FSH),and fewer oocytes obtained,normal fertilization,available embryos and high quality embryos.More importantly,we found that the rate of early pregnancy loss in the two groups was similar,while the pregnancy rate in the low AMH group was significantly lower than that in the high AMH group.Further analysis shows that it may be due to the higher pregnancy rate of women in the high AMH group due to the large number of high quality embryos transferred.In addition,in the low AMH group,the majority were older than or equal to 35 years old(69.9%),while in the high AMH group,the majority were younger than 35 years old(61.2%),which was consistent with the known clinical conclusion that the older the age,the lower the AMH level.However,after univariate analysis,curve fitting and comprehensive evaluation of multiple regression equation,it was not concluded that there was a correlation between the level of AMH and the loss of early pregnancy.To sum up,this study shows that there is little correlation between AMH and early pregnancy loss,and the role of AMH in predicting the developmental ability of embryos in vitro is not obvious,suggesting that AMH should not be used as a marker of oocyte quality in the cycle of in vitro fertilization and embryo transfer.Conclusion: There is no significant correlation between AMH level and early pregnancy loss after IVF fresh embryo transfer,so it can not be used as one of the indexes to predict the quality of oocytes.