血清抗苗勒管激素水平对子宫内膜异位症合并不孕患者术后妊娠的影响
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摘要
目的通过分析子宫内膜异位症(endometriosis,EMs)合并不孕患者手术前后血清抗苗勒管激素(anti-müllerian hormone,AMH)水平及术后妊娠结局,探讨EMs合并不孕患者AMH水平对术后妊娠的影响。方法选取腹腔镜检查确诊为EMs合并不孕患者104例,其中盆腔腹膜型EMs 60例(腹膜型组),卵巢子宫内膜异位囊肿44例(卵巢型组);均行腹腔镜手术治疗,检测术前、术后3个月血清AMH水平,术后给予相应的妊娠指导,其中期待自然妊娠者33例(自然妊娠组)、行促排卵-人工授精(COH-IUI)25例(COH-IUI组)、行体外受精-胚胎移植(IVF-ET)46例(IVF-ET组)。术后随访1年,观察104例患者妊娠结局,并比较妊娠组与未妊娠组术前及术后3个月血清AMH水平。结果 104例患者术后1年妊娠53例,未妊娠51例,累积妊娠率为50.96%。自然妊娠组、COH-IUI组、IVF-ET组患者术后3个月AMH水平与术前比较均有下降,但差异无统计学意义(P>0.05);3种妊娠方式中妊娠组术前血清AMH水平均显著高于未妊娠组(P<0.05)。腹膜型组、卵巢型组患者术后3个月AMH水平与术前比较均有下降,但差异均无统计学意义(P>0.05);2种EMs类型中妊娠组术前血清AMH水平均显著高于未妊娠组(P<0.05)。结论血清AMH水平反映卵巢的储备功能,手术对血清AMH水平无明显影响,术前血清AMH水平可作为预测子宫内膜异位症合并不孕患者术后妊娠的指标。
Objective To investigate the effects of serum anti-müllerian hormone(AMH) levels on postoperative pregnancy in infertile patients with endometriosis(EMs) through determining pre-and post-operative AMH concentrations and pregnancy outcomes.Methods Laparoscopic surgery was performed and serum AMH levels were measured before and 3 months after operation in 104 infertile patients with laparoscopy-confirmed EMs,including 60 patients with pelvic peritoneal EMs(peritoneal group) and 44 patients with cystic ovarian endometriosis(ovarian group).Postoperative pregnancy guidance was given in both groups.In addition,these patients were divided into natural pregnancy group(33 patients),controlled ovarian hyperstimulation and intrauterine insemination(COH-IUI) group(25 patients),and in vitro fertilization and embryo transfer(IVF-ET) group(46 patients).Pregnancy outcomes were observed after follow-up for 1 year.Pre-and post-operative serum AMH levels were compared between pregnant group and non-pregnant group.Results Among the 104 patients,53 were pregnant and 51 were not pregnant within 1 year after operation.The cumulative pregnancy rate was 50.96%.Compared with preoperative levels,serum AMH decreased 3 months after operation.However,the differences were not significant among natural pregnancy,COH-IUI and IVF-ET groups,as well as between peritoneal or ovarian group(P>0.05).Compared with non-pregnant group,serum AMH levels obviously increased in pregnant group(P<0.05).Conclusion Serum AMH levels reflect ovarian reserve function.The surgery has no effect on serum AMH levels.Preoperative AMH levels can be used as a predictor of postoperative pregnancy in infertile patients with EMs.
Objective To investigate the effects of serum anti-müllerian hormone(AMH) levels on postoperative pregnancy in infertile patients with endometriosis(EMs) through determining pre-and post-operative AMH concentrations and pregnancy outcomes.Methods Laparoscopic surgery was performed and serum AMH levels were measured before and 3 months after operation in 104 infertile patients with laparoscopy-confirmed EMs,including 60 patients with pelvic peritoneal EMs(peritoneal group) and 44 patients with cystic ovarian endometriosis(ovarian group).Postoperative pregnancy guidance was given in both groups.In addition,these patients were divided into natural pregnancy group(33 patients),controlled ovarian hyperstimulation and intrauterine insemination(COH-IUI) group(25 patients),and in vitro fertilization and embryo transfer(IVF-ET) group(46 patients).Pregnancy outcomes were observed after follow-up for 1 year.Pre-and post-operative serum AMH levels were compared between pregnant group and non-pregnant group.Results Among the 104 patients,53 were pregnant and 51 were not pregnant within 1 year after operation.The cumulative pregnancy rate was 50.96%.Compared with preoperative levels,serum AMH decreased 3 months after operation.However,the differences were not significant among natural pregnancy,COH-IUI and IVF-ET groups,as well as between peritoneal or ovarian group(P>0.05).Compared with non-pregnant group,serum AMH levels obviously increased in pregnant group(P<0.05).Conclusion Serum AMH levels reflect ovarian reserve function.The surgery has no effect on serum AMH levels.Preoperative AMH levels can be used as a predictor of postoperative pregnancy in infertile patients with EMs.
引文
[1] FLEMING R,SEIFER D B,FRATTARELLI J L,et al.Assessing ovarian response:antral follicle count versus anti-Müllerian hormone[J].Rcprod Biomcd Online,2015,31(4):486-496.
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[3] 中华医学会妇产科分会内异症协作组.子宫内膜异位症诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[4] FANCHIN R,SCHONAUER L M,RIGHINI C,et al.Serum anti-müllerian hormone is more strongly related to ovarian follicular status than serum inhibin B,estradiol,FSH and LH on day 3[J].Hum Reprod,2003,18(2):323-327.
[5] HEHENKAMP W J,LOOMAN C W,THEMMEN A P,et al.Anti-müllerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation[J].J Clin Endocrinol Metab,2006,91(10):4057-4063.
[6] DEB S,CAMPBELL B K,PINCOTT ALLEN C,et al.Quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti-müllerian hormone and small antral follicle count using three-dimensional ultrasound[J].Ultrasound Obstet Gynecol,2012,39(5):574-580.
[7] KRISTENSEN S L,RAMLAU HANSEN C H,ANDERSEN C Y,et al.The association between circulating levels of anti-müllerian hormone and follicle number,androgens,and menstrual cycle characteristics in young women[J].Fertil Steril,2012,97(3):779-785.
[8] WAHD S A,ALALAF S K,ALSHAWAF T,et al.Ovarian reserve marketsand assisted reproductive technique(ART)outcomes in women with advanced endometriosis[J].Reprod Biol Endocrino1,2014,12:120.
[9] CORIC M,BARISIC D,PAVICIC D,et al.Electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas assessed by antral follicle count:preliminary results of randomized clinical trial[J].Arch Gynecol Obstet,2011,283(2):373-378.
[10] SUGITA A,IWASE A,GOTO M,et al.One-year follow-up of serum anti-müllerian hormone levels in patients with cystectomy:are different sequential changes due to different mechanisms causing damage to the ovarian reserve[J].Fertil Steril,2013,100(2):516-522.
[11] LEE D Y,YOUNG KIM N,JAE KIM M,et al.Effects of laparoscopic surgery on serum anti-Müllerian hormone levels in reproductive -aged women with endometrioma[J].Gynecol Endocrinol,2011,27(10):733-736.
[12] WANG M H,CHEN C H,WANG C W,et al.A higher anti-müllcrian hormone level is associated with an increased chance of pregnancy in patients undergoing controlled ovarian stimulation and intrauterine insemination[J].J Obstet Gvnaecol,2015,35(1):64-68.
[2] STREULI I,DE ZIEGLER D,GAYET V,et al.In women with endometriosis anti -Müllcrian hormone levels are decreased only in those with previous endomctrioma surgcry[J].Hum Rcprod,2012,27(11):3294-3303.
[3] 中华医学会妇产科分会内异症协作组.子宫内膜异位症诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[4] FANCHIN R,SCHONAUER L M,RIGHINI C,et al.Serum anti-müllerian hormone is more strongly related to ovarian follicular status than serum inhibin B,estradiol,FSH and LH on day 3[J].Hum Reprod,2003,18(2):323-327.
[5] HEHENKAMP W J,LOOMAN C W,THEMMEN A P,et al.Anti-müllerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation[J].J Clin Endocrinol Metab,2006,91(10):4057-4063.
[6] DEB S,CAMPBELL B K,PINCOTT ALLEN C,et al.Quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti-müllerian hormone and small antral follicle count using three-dimensional ultrasound[J].Ultrasound Obstet Gynecol,2012,39(5):574-580.
[7] KRISTENSEN S L,RAMLAU HANSEN C H,ANDERSEN C Y,et al.The association between circulating levels of anti-müllerian hormone and follicle number,androgens,and menstrual cycle characteristics in young women[J].Fertil Steril,2012,97(3):779-785.
[8] WAHD S A,ALALAF S K,ALSHAWAF T,et al.Ovarian reserve marketsand assisted reproductive technique(ART)outcomes in women with advanced endometriosis[J].Reprod Biol Endocrino1,2014,12:120.
[9] CORIC M,BARISIC D,PAVICIC D,et al.Electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas assessed by antral follicle count:preliminary results of randomized clinical trial[J].Arch Gynecol Obstet,2011,283(2):373-378.
[10] SUGITA A,IWASE A,GOTO M,et al.One-year follow-up of serum anti-müllerian hormone levels in patients with cystectomy:are different sequential changes due to different mechanisms causing damage to the ovarian reserve[J].Fertil Steril,2013,100(2):516-522.
[11] LEE D Y,YOUNG KIM N,JAE KIM M,et al.Effects of laparoscopic surgery on serum anti-Müllerian hormone levels in reproductive -aged women with endometrioma[J].Gynecol Endocrinol,2011,27(10):733-736.
[12] WANG M H,CHEN C H,WANG C W,et al.A higher anti-müllcrian hormone level is associated with an increased chance of pregnancy in patients undergoing controlled ovarian stimulation and intrauterine insemination[J].J Obstet Gvnaecol,2015,35(1):64-68.