Effects Of Anti-mullerian Hormone On Pregnancy Outcome Of Assisted Reproductive Therapy In Elderly Women

Objective: To evaluate the predictive value of serum amr levels on ovarian response and clinical outcomes in older women undergoing IVF/ICSI,so as to provide more guidance for older women undergoing assisted conception.Methods:An analysis was made of 232 patients who received the first assisted pregnancy treatment in the department of reproductive medicine of our hospital from January 2018 to October 2019,including patients' age,body mass index(BMI),follicular stimulating hormone(FSH),anti-mullerian hormone(AMH)and antral follicle count.AFC),number of high-quality embryos,endometrium(EM),gonadotropin(Gn)dosage,Gn days,clinical pregnancy rate,early pregnancy abortion rate.The included patients were divided into three groups: lower age group(35-37 years old,n=94),middle age group(38-40 years old,n=77),and higher age group(> 40 years old,n=61).(2)to evaluate the relationship between AMH level and other detection indicators and the number of eggs harvested in each group;(3)patients were divided into the pregnant group and the non-pregnant group according to whether they were pregnant or not.Differences in basic conditions and detection indicators were compared among the groups.The indicators with statistical differences were included in Logistic regression to screen theindicators that could independently predict pregnancy and assess the efficacy according to the ROC operating curve described by the regression model.(5)the above-mentioned indicators affecting clinical pregnancy were incorporated into the Logistic model to screen the indicators that can independently predict early pregnancy abortion.Results:(1)The AMH level showed a downward trend with the increase of age among the three groups,and the difference was statistically significant(P < 0.05).On the contrary,the body mass index increased slightly among the three age groups,but there was no statistical difference;(2)In each age group,the number of eggs harvested and the number of transplantable embryos decreased with the decrease of AMH,and the difference was statistically significant(P < 0.05).Spearman correlation analysis showed that AMH level was positively correlated with the number of eggs harvested and the number of transplantable embryos;(3)Age,number of transplantable embryos and AMH could independently predict clinical pregnancy(OR=0.931,OR=0.67,OR=1.58,P < 0.05).Age,number of transplantable embryos and AMH were included in the ROC curve to describe the predictive efficacy,and the results showed that the predictive ability was low;(4)Early pregnancy loss rate increased with age among the three groups.The Logistic regression model showed that only age was an independent predictor,not AMH level.Conclusion:(1)Serum AMH level decreases with age,which can predict the number of eggs harvested and the number of transplantable embryos;(2)Age can be used as an independent risk factor for clinical pregnancy,and the number of transplantable embryos and AMH level can be used as independent protective factors for clinical pregnancy,but the predictive efficacy of the three is low;(3)only age,not AMH,was a factor affecting early loss of pregnancy.