The Value Of Serum AMH In Predicting The Clinical Pregnancy In Advanced Patients Undergoing IVF-ET

Objective:To retrospectively analyze the factors that influencing clinical pregnancy of IVF-ET of advanced women in different ages in infertile women of different ages,and evaluate the value of AMH in predicting clinical pregnancy of IVF/ICSI of advanced women of different ages,evaluate the value of AMH and ages in predicting clinical pregnancy in the IVF-ET,aiming to provide evidence for assisting reproductive counseling and treatment for advanced infertile women.Methods:The advanced infertile women who underwent IVF-ET/ICSI-ET at the Reproductive Center from January 2015 to December 2016 were included in this study.Information of age,BMI,infertility duration,basal FSH,basal LH,basal E₂,AMH,AFC,endometrial thickness on the day of embryo transfer,Gn dose,Gn days,mature oocyte rate,clinical pregnancy were collected.1.Describe the patient's basic condition.Patients were divided into four groups according to their age,Group A:35-37 years old;Group B:38-40 years old;Group C:41-42 years old,Group D:>42 years old,describing AMH of infertile women in different ages.2.Comparing the correlation between AMH levels and the number of oocytes obtained in women of different ages,and analyzing the relationship between AMH levels and the number of oocytes retrieved from advanced women.3.Compare the basic conditions,laboratory and clinical indicators of the patients in the pregnant and non-pregnant groups for statistical differences.According to the AMH level?AMH in low,medium,and high tertiles?,these subjects were divided into three groups:low AMH level group?AMH<1.21 ng/mL?,medium level group?AMH1.21-2.57 ng/mL?,and high level group?AMH>2.57 ng/mL?.Analyze the differences in the basic conditions,laboratories and clinical indicators among the three groups.The above statistically significant factors were included in the binary logistic regression to investigate the independent factors affecting pregnancy in IVF-ET.4.The age,AMH,and total number of eggs were included in the ROC curve to analyze the clinical indicators of clinical pregnancy prediction.5.Observe the change of AMH level and clinical pregnancy rate in elderly infertile women of different ages.Results:1.A total of 253 advanced infertile patients undergoing IVF-ET were admitted to research.The AMH levels of women aged 35 to 37 was significantly higher than those of women older than 37 and there was a decreasing tendency in AMH level with age.2.For advanced infertile women less than 42 years old,there was a linear positive correlation between AMH and the number of eggs obtained,which was statistically significant.For women over 42,there was no correlation between the number of retrieved eggs and AMH levels.3.Compared the pregnant group with the non-pregnant group,there was a significant difference in the age,AFC,number of oocytes retrieved,and number of transferred embryos.Compared patients in different AMH levels in their age,basic FSH and LH,AFC,AMH,Gn dosage,number of oocytes retrieved,number of transplanted embryos,difference was significantly different.The analysis of the significantly different factors in the logistic regression model found that age,number of oocytes,and AMH levels were independent predictors of clinical pregnancy,but the amounts of basal FSH,basic LH,AFC,and Gn were not independent factors of clinical pregnancy.4.The ROC curve suggests that age,number of oocytes retrieved,and AMH level all predict clinical pregnancy ability,which is statistically significant.The number of obtained eggs predicted the best clinical pregnancy ability,with a cut-off value of 5,?sensitivity:62.2%;specificity:69.3%?.Age in clinical pregnancy is less predictive than the number of retrieved eggs,but its sensitivity is the highest.The age of the cut-off value for clinical pregnancy is 38 years old.AMH can only predict clinical pregnancy with limited value.5.Regardless of the AMH level,the clinical pregnancy rate decreases with age,the age has a greater impact on clinical pregnancy than AMH.AMH was more influential on clinical pregnancy rate aged over 37 years old than those aged between35 and 37 years old.Conclusion:1.There is a positive correlation between the AMH level and the number of retrieved eggs in advanced infertile women younger than 42 years old.2.Age,AMH and the number of retrieved eggs are the independent influential factors of clinical pregnancy.3.The number of retrieved eggs has the highest clinical pregnancy predictive value,with a cut-off value of 5.While the age has lower value in predicting clinical pregnancy than the number of retrieved eggs,and the cut-off value is 38 years.AMH can also predict clinical pregnancy and the cut-off value is 1.853 ng/mL.4.Age has a greater impact on clinical pregnancy than AMH.AMH is a more significant indicator in patients aged over 37 years old.