| Objectives:In this study,we analyzed the pregnancy outcomes of diminished ovarian reserve(DOR)patients after assisted conception at different ages and different low anti-Müllerian hormone(AMH)extraction intervals and explored the factors affecting clinical pregnancy with a view to providing some guidance to patients when undergoing assisted reproductive technology(ART)treatment.Methods:Patients with DOR who attended the Second Hospital of Jilin University for intrauterine insemination(IUI)or In vitro fertilization-embryo transfer(IVF-ET)treatment from January 2018 to January 2022 were selected,of whom a total of 462 cases met the inclusion criteria.(i)Patients who met the inclusion criteria were first divided into the IUI group(group A)and the IVF-ET group(group B)according to the mode of assisted conception.Group A and B were divided into a very low AMH level group(AMH ≤0.5ng/m L)(group A1,group B1)and a low AMH level group(0.5ng/m L < AMH <1.1ng/m L)(group A2,group B2)according to AMH level.group A and B were divided into a young group(group A3,group B3)and an advanced group(group A4,group B4)according to whether the age was ≥ 35 years.(ii)Groups A and B were divided into pregnancy and non-pregnancy groups according to whether they were pregnant or not.Three main parts were explored: the first was to explore the pregnancy outcomes of DOR patients with different AMH levels after congenital assisted reproduction;the second was to explore the pregnancy outcomes of DOR patients at different ages after congenital assisted reproduction;and the third was to explore the independent factors affecting clinical pregnancy in DOR patients.Results:Part 1:Among DOR patients undergoing IUI for conception,group A1(AMH ≤0.5ng/m L)was compared with group A2(0.5ng/m L<AMH<1.1ng/m L): body mass index(BMI),years of infertility,type of infertility,basal luteinizing hormone(b LH),basal estradiol(b E2),days of gonadotropins(Gn)use,human menopausal gonadotropin(HCG)daily progesterone(P)level,male sperm concentration after treatment,percentage of forward motile sperm,total sperm viability,cycle cancellation rate,in both groups miscarriage rate and live birth rate were not statistically different(P > 0.05);however,age,basal follicle-stimulating hormone(b FSH),initial Gn dose and total Gn dose were higher in group A1 than in group A2(P<0.05),and antral follicle count(AFC),E2 level on HCG day,endometrial thickness on HCG day,number of follicles on HCG day,and clinical pregnancy rate were all lower than in group A2(P<0.05).Among DOR patients undergoing IVF-ET assisted conception,group B1(AMH≤ 0.5ng/m L)was compared with group B2(0.5ng/m L < AMH < 1.1ng/m L): BMI,years of infertility,type of infertility,b LH,b E2,days of Gn use,HCG daily P level,MII egg rate,fertilisation rate,normal egg cleavage rate,transferable embryo rate,quality embryo rate,male sperm concentration after treatment,percentage of forward motile sperm,total sperm motility,cycle cancellation rate,live birth rate,and miscarriage rate were not statistically different(P>0.05).However,the age,b FSH,the initial dose of Gn,the total dose of Gn,and unusable embryo rate of group B1 were higher than those of group B2(P<0.05),AFC,E2 level and endometrial thickness on HCG day,number of follicles on HCG day,number of oocytes retrieved,number of 2 Pronuclear(2PN),number of 2PN cleavage,number of transferable embryos,number of high-quality embryos,embryo implantation rate,and clinical pregnancy rate were lower than those in group B2(P<0.05)Part 2:Comparison of group A3(<35 years)with group A4(≥35 years)among DOR patients undergoing IUI for pregnancy: BMI,years of infertility,type of infertility,b LH,b E2,initial Gn dose,days of Gn use,HCG daily E2 level,HCG daily P level,HCG daily endometrial thickness,male sperm post-treatment concentration,percentage of forward motion sperm,total sperm viability in both groups,cycle cancellation rate,miscarriage rate,and live birth rate were not statistically different(P>0.05).However,the total dose of b FSH and Gn in group A3 was lower than that in group A4(P < 0.05),and the daily follicle number and clinical pregnancy rate in AFC,AMH and HCG were higher than that in group A4(P < 0.05).In DOR patients undergoing IVF-ET assisted conception,group B3(<35 years)was compared with group B4(≥35 years): BMI,years of infertility,b LH,b E2,initial Gn dose,days of Gn use,E2 level on HCG day,P level on HCG day,endometrial thickness on HCG day,number of follicles on HCG day,number of eggs gained,MII egg rate,fertilization rate,2PN number,2PN egg cleavage number,normal egg cleavage rate,number of transferable embryos,number of good quality embryos,male sperm concentration after treatment,percentage of forward motile sperm,total sperm viability and miscarriage rate were not statistically different(P>0.05).However,in terms of infertility type,primary infertility was dominant in group B3,while secondary infertility was dominant in group B4,and the total dose of b FSH and Gn,unusable embryo rate and cycle cancellation rate in group B3 were lower than those in group B4(P < 0.05).AFC,AMH,transplantable embryo rate,high-quality embryo rate,embryo implantation rate,clinical pregnancy rate and live birth rate were higher than those in B4 group(P < 0.05).Part 3:Comparison between pregnant group and non-pregnant group: BMI,infertility years,infertility types,basal FSH,basal LH,basal E2,AFC,initial amount of Gn,total amount of Gn,and Gn of the two groups of patients There were no significant differences in days of use,E2 level on HCG day,P level on HCG day,endometrial thickness on HCG day,follicle number on HCG day,concentration of male sperm after treatment,percentage of forward motile sperm and total sperm motility(P >0.05).However,the age distribution of patients in clinical pregnancy group was lower than that in non-clinical pregnancy group(P < 0.05),and the proportion of AMH and IVF-ET assisted pregnancy was higher than that in non-clinical pregnancy group(P <0.05).Variables with P < 0.05 in univariate analysis(age(< 35 years old =1,≥35years old =2),AMH,assisted pregnancy method(IUI=0,IVF=1))were taken as independent variables,and whether pregnancy was a dependent variable(non-pregnancy =0,pregnancy =1)was taken into the binary logistic regression analysis model.The results showed that: Age(OR= 0.572,95%CI: 0.353-0.928,P=0.024),AMH level(OR= 16.721,95%CI: 5.769-48.470,P=0.000),assisted pregnancy method(OR=2.583,95%CI: 1.420-4.699,P=0.002)was an independent factor affecting the clinical pregnancy outcome of patients with DOR.Conclutions:1.Patients with DOR and low AMH levels had lower clinical pregnancy rates in the AMH ≤0.5ng/ml than in the 0.5ng/m L<AMH<1.1ng/m L group,regardless of whether they were assisted with an IUI protocol or an IVF-embryo transfer protocol;there was no difference in live birth or miscarriage rates between the two.2.After treatment with the IUI protocol in DOR patients of different age groups,the clinical pregnancy rate was higher in the younger group than in the older group,while there was no difference in the live birth and miscarriage rates between them.3.After treatment with the in vitro fertilization and embryo transfer protocol for DOR patients of different age groups,the clinical pregnancy rate and live birth rate were higher in the younger group than in the older group,while there was no difference in the miscarriage rate.4.Age,AMH level and assisted pregnancy were independent factors affecting the pregnancy outcome of patients with DOR. |
PDF Full Text Request