AMH預測COH結果及卵巢功能優於基礎濾泡

Fertil Steril. 2015 Apr;103(4):923-930.e1. doi: 10.1016/j.fertnstert.2014.12.114. Epub 2015 Jan 24.

Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials.

Nelson SM1, Klein BM2, Arce JC3.

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Abstract

OBJECTIVE:

To compare antimüllerian hormone (AMH) and antral follicle count (AFC) as predictors of ovarian response to controlled ovarian stimulation at individual fertility clinics.

DESIGN:

Retrospective analysis of individual study center data in two multicenter trials. Centers that provided >10 patients were included in the analysis.

SETTING:

A total of 19 (n = 519 patients) and 18 study centers (n = 686 patients) participating in a long GnRH agonist trial (MERIT) and a GnRH antagonist trial (MEGASET), respectively.

PATIENT(S):

Infertile women of good prognosis.

INTERVENTION(S):

Long GnRH agonist or GnRH antagonist cycles.

MAIN OUTCOME MEASURE(S):

Correlation between AMH and AFC, and oocyte yield by each study center for each trial.

RESULTS(S):

Antimüllerian hormone was more strongly correlated with oocyte yield than AFC: r = 0.56 vs. r = 0.28 in the GnRH agonist cohort, and r = 0.55 vs. r = 0.33 in the GnRH antagonist cohort. The correlation was numerically higher for AMH than for AFC at a significantly higher proportion of study centers: 17 (89%) and 15 (83%) centers in the long GnRH agonist and GnRH antagonist trial, respectively. Assessment of the relative capacity of AMH and AFC for predicting oocyte yield demonstrated that AMH dominated the model: AMH, R(2) = 0.29 and 0.23; AFC: R(2) = 0.07 and 0.07; AMH + AFC: R(2) = 0.30 and 0.23 for long GnRH agonist and GnRH antagonist trials, respectively.

CONCLUSIONS(S):

Antimüllerian hormone was a stronger predictor of ovarian response to gonadotropin therapy than AFC at the study center level in both randomized trials utilizing GnRH agonist and GnRH antagonist protocols. Antral follicle count provided no added predictive value beyond AMH.