抗苗勒管激素与不明原因复发性流产的活产率。

Anti-Müllerian hormone and live birth in unexplained recurrent pregnancy loss.

机构信息

Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), 2100 Copenhagen, Denmark.

Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark.

出版信息

Reprod Biomed Online. 2023 Jun;46(6):995-1003. doi: 10.1016/j.rbmo.2023.01.023. Epub 2023 Feb 3.

DOI:10.1016/j.rbmo.2023.01.023

PMID:37055255

Abstract

RESEARCH QUESTION

Is anti-Müllerian hormone (AMH) associated with live birth rate (LBR) in women with unexplained recurrent pregnancy loss (RPL)?

DESIGN

Cohort study of women with unexplained RPL attending the RPL Unit, Copenhagen University Hospital, Denmark, between 2015 and 2021. AMH concentration was assessed upon referral, and LBR in the next pregnancy. RPL was defined as three or more consecutive pregnancy losses. Regression analyses were adjusted for age, number of previous losses, body mass index, smoking, treatment with assisted reproductive technology (ART) and RPL treatments.

RESULTS

A total of 629 women were included; 507 (80.6%) became pregnant after referral. Pregnancy rates were similar for women with low and high AMH compared to women with medium AMH (81.9, 80.3 and 79.7%, respectively) (low AMH: adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 0.84-2.47, P = 0.18; high AMH: aOR 0.98, 95% CI 0.59-1.64, P = 0.95). AMH concentrations were not associated with live birth. LBR was 59.5% in women with low AMH, 66.1% with medium AMH and 65.1% with high AMH (low AMH: aOR 0.68, 95% CI 0.41-1.11, P = 0.12, high AMH: aOR 0.96, 95% CI 0.59-1.56, P = 0.87). Live birth was lower in ART pregnancies (aOR 0.57, 95% CI 0.33-0.97, P = 0.04) and with higher numbers of previous losses (aOR 0.81, 95% CI 0.68-0.95, P = 0.01).

CONCLUSION

In women with unexplained RPL, AMH was not associated with the chances of live birth in the next pregnancy. Screening for AMH in all women with RPL is not supported by current evidence. The chance of live birth among women with unexplained RPL achieving pregnancy by ART was low and needs to be confirmed and explored in future studies.

摘要

研究问题

抗苗勒氏管激素（AMH）与不明原因复发性流产（RPL）女性的活产率（LBR）相关吗？

设计

丹麦哥本哈根大学医院 RPL 科对 2015 年至 2021 年期间就诊的不明原因 RPL 女性进行的队列研究。在转诊时评估 AMH 浓度，在下一次妊娠时评估活产率。RPL 定义为连续三次或更多次妊娠丢失。回归分析调整了年龄、既往流产次数、体重指数、吸烟、辅助生殖技术（ART）治疗和 RPL 治疗。

结果

共纳入 629 名女性；507 名（80.6%）在转诊后怀孕。与中 AMH 水平的女性相比，低 AMH 和高 AMH 水平的女性妊娠率相似（分别为 81.9%、80.3%和 79.7%）（低 AMH：调整后的优势比[aOR]1.44，95%置信区间[CI]0.84-2.47，P=0.18；高 AMH：aOR 0.98，95%CI 0.59-1.64，P=0.95）。AMH 浓度与活产无关。低 AMH 女性的活产率为 59.5%，中 AMH 女性为 66.1%，高 AMH 女性为 65.1%（低 AMH：aOR 0.68，95%CI 0.41-1.11，P=0.12；高 AMH：aOR 0.96，95%CI 0.59-1.56，P=0.87）。ART 妊娠的活产率较低（aOR 0.57，95%CI 0.33-0.97，P=0.04），且既往流产次数较多（aOR 0.81，95%CI 0.68-0.95，P=0.01）。