4.7 Article

Pretreatment antimiillenan hormone levels and outcomes of ovarian stimulation with gonadotropins/intrauterine insemination cycles

期刊

FERTILITY AND STERILITY
卷 116, 期 2, 页码 422-430

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ELSEVIER SCIENCE INC
DOI: 10.1016/j.fertnstert.2021.02.047

关键词

AMH; gonadotropins; ovarian stimulation; intrauterine insemination

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The study suggests that in women undergoing gonadotropin stimulation/intrauterine insemination, serum antimilllerian hormone (AMH) levels are associated with the probability of achieving a clinical pregnancy and may have a negative impact on the risk of spontaneous abortion.
Objective: To evaluate the association, if any, between serum antimilllerian hormone (AMH) levels and probability of clinical pregnancy and spontaneous abortion (SAB) in the infertility setting. Design: Retrospective cohort study. Setting: Academic fertility center. Patient(s): A total of 1,861 gonadotropin stimulation/intrauterine insemination cycles stratified by AMH levels into 3 groups: Low, <25th percentile (<0.7 ng/mL); Middle, >= 25th and <75th percentile (0.7-4.4 ng/mL); and High, >= 75th percentile (>= 4.5 ng/mL). Intervention(s): Intrauterine insemination after stimulation with gonadotropins. Main Outcome Measure(s): Cumulative probability of clinical pregnancy over a maximum of 3 and/or 6 cycles and SAB incidence risk rate (IRR). The Kaplan-Meier failure function (log rank test), Cox proportional hazards models, and multilevel mixed-effects Poisson regression models were performed to compare outcomes among the AMH groups. Result(s): Overall, in both unadjusted and adjusted models, the probability of achieving a clinical pregnancy was higher in the Middle and High AMH groups compared with that in the Low AMH group, both over 3 (hazard ratios [95% confidence interval], 1.55 [1.05-2.29] and 1.85 [1.22-2.81], respectively) and 6 (1.71 [1.17-2.48] and 2.12 [1.42-3.16], respectively) cycles. In the unadjusted models, the SAB IRR was higher among the Low AMH group (IRR [95% confidence interval], 2.17 (1.11-4.241), with the relationship persisting after adjusting for age (1.83 [0.93-3.60]). When the SAB IRR were calculated separately for the subpopulations with and without polycystic ovary syndrome, a similar relationship was noted among the latter in the unadjusted (1.94 [0.97-3.88]) and adjusted (1.74 [0.86-3.49]) analyses. Conclusion(s): In women undergoing gonadotropin stimulation/intrauterine insemination, AMH appears to affect the probability of achieving a clinical pregnancy. A possible negative impact, independent of age, on the risk of SAB was also suggested. (C) 2021 by American Society for Reproductive Medicine.

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