Clinical value of determining serum AMH in GnRH agonist long protocol——a modified CONSORT algorithm for individualized dosing of FSH

目的 研究抗苗勒管激素(AMH)水平与卵巢储备及卵巢反应性的关系,并探讨可供个体化FSH剂量的改良CONSORT公式.方法 回顾性研究2015年10月至2016年4月北京大学人民医院生殖医学中心经长方案促排卵治疗的年龄23~40岁的130例不孕症患者临床资料;以Howles提出的CONSORT公式为基础,引入新变量AMH(改良CONSORT公式),并将公式中FSH启动剂量改为平均剂量(修正CONSRT公式),以及在引入AMH变量的同时将FSH启动剂量改为FSH平均剂量(修正的改良CONSORT公式);采用多元线性回归分析方法得到经典CONSORT公式、改良CONSORT公式、修正CONSORT公式及修正的改良CONSORT公式;得出各公式后,通过代入各项变量,得出理论获卵数量,计算其与实际获卵数的关系,分析并验证各公式的优劣.结果 (1)AMH水平与年龄、基础FSH水平、FSH起始剂量/FSH平均剂量呈负相关,与获卵数量呈正相关;(2)FSH平均剂量与获卵数量呈正相关,FSH起始剂量与获卵数量无明显相关;(3)统计学结果表明,改良CONSORT公式(R 2=0.694,P<0.0001,Σ(S-Y) 2=15.42)优于经典CONSORT公式(R 2=0.693,P<0.0001,Σ(S-Y) 2=17.05);修正CONSORT公式(R 2=0.696,P<0.0001,Σ(S-Y) 2=13.91)优于经典CONSORT公式;修正的改良CONSORT公式(R 2=0.698,P~0,Σ(S-Y) 2=10.87)优于经典CONSORT公式、改良CONSORT公式或修正CONSORT公式.结论 AMH水平能预测卵巢储备及卵巢的反应性,引入AMH变量并将FSH启动剂量改为FSH平均剂量的修正改良CONSORT公式更能准确预测患者的卵巢反应性,有利于精确地指导FSH起始剂量.Objective:To study the relationship between AMH levels and ovarian reserve & reactivity,and explore the modified CONSORT formula for individualized dosing of FSH.Methods:The data of 130 infertile patients aged 23 to 40 who were treated with GnRH agonist long protocol in our reproductive center from Oct.2015 to Apr.2016 were retrospectively analyzed.Based on the CONSORT formula proposed by Howles,firstly,the new variable AMH was introduced into the formula (modified CONSORT formula);Secondly the initial FSH dose was replaced by average FSH dose in the formula (corrected CONSRT formula);Finally,the initial FSH dose was replaced by average FSH dose while the AMH variable was introduced into the formula (corrected & modified CONSRT formula).The classical CONSORT formula,modified CONSORT formula,corrected CONSORT formula and corrected & modified CONSORT formula were obtained by multiple linear regression analysis.After the formulas are obtained,the number of theoretical oocytes retrieved was obtained by substituting the variables,and then the relationship between theoretical oocytes retrieved and the actual number of oocytes retrieved was analyzed.The merits and weakness of each formula was analyzed and verified.Results:(1) AMH level was negatively correlated with age,FSH level,FSH initial dose or FSH average dose,and positively correlated with the number of oocytes retrieved.(2) The number of oocytes retrieved was positively correlated with the FSH average dose,but the initial FSH dose was not significantly correlated with the number of retrieved oocytes.The statistical results show that the modified CONSORT formula(R 2=0.694,P<0.0001,Σ(S-Y) 2=15.42)is better than the classical CONSORT formulas(R 2=0.693,P<0.0001,Σ(S-Y) 2=17.05).The corrected CONSORT formula(R 2=0.696, P<0.000 1,Σ(S-Y) 2=13.91)was better than the classical CONSORT formulas;and the corrected & modified CONSORT formula(R 2=0.698,P~0,Σ(S-Y) 2=10.87)was better than the other three formulas.Conclusions:AMH level can predict the ovarian reserve and response.Corrected & modified CONSORT algorithm can predict ovarian response and the patient's treatment outcome more accurately.It is helpful to accurately guide the FSH initial dose.7634-6392