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대한생식의학회지 제35권 제4호 2010년
과배란유도 시 혈중 AMH와 난소 반응성과의 상관관계; 예측 인자로서의 효용성
관동대학교 의과대학 제일병원 산부인과
안영선§•김진영*•조연진•김민지•김혜옥•박찬우•송인옥•궁미경•강인수,
Correlation of Basal AMH & Ovarian Response in IVF Cycles; Predictive Value of AMH
Young Sun Ahn¡×, Jin Yeong Kim*, Yun Jin Cho, Min Ji Kim, Hye Ok Kim,Chan Woo Park, In Ok Song, Mi Kyoung Koong, Inn Soo Kang
Department of Obstetrics & Gynecology, Cheil General Hospital, Kwandong University,College of Medicine, Seoul, Korea
Objectives: The aim of this study was to evaluate the usefulness of Anti-m?llerian hormone (AMH) as a predictive marker for ovarian response and cycle outcome in IVF cycles. Methods: From Jan., to Aug., 2007, 111 patients undergoing IVF/ICSI stimulated by short or antagonist protocol were selected. On cycle day 3, basal serum AMH level and FSH level were measured. The correlation between basal serum AMH or FSH, and COH outcome was analyzed and IVF outcome was compared according to the AMH levels. To determine the threshold value of AMH for poor- and hyper- response, ROC curve was analyzed. Results: Serum AMH showed higher correlation coefficient (r=0.792, p<0.001) with the number of retrieved mature oocyte than serum FSH (r=-0.477, p<0.001). According to ovarian response, FSH and AMH leves showed significant differences among poor, normal , and hyperresponder. For predicting poor (≤2 oocytes) and hyperresponse (≥17 oocyets), AMH cut-off values were 0.5 ng/ml (the sensitivity 88.9% and the specificity 89.5%) and 2.5 ng/ml (sensitivity 85.7%, specificity 87.0%), respectively. According to the AMH level, patients were divided into 3 groups: low (≤0.60 ng/ml), normal (0.60~2.60 ng/ml), and high AMH (≥2.60 ng/ml). The number of retrieved mature oocytes was significantly higher (2.7±2.2, 8.1±4.8, 16.5±5.7) and total gonadotropin dose was lower (3530.5±1251.0, 2957.1±1057.6, and 2219.2±751.9 IU) in high AMH group (p<0.001). There was no significant difference in fertilization rates and pregnancy rates (23.8%, 34.0%, 37.5%) among the groups. Conclusions: Basal serum AMH level correlated better with the number of retrieved mature oocytes than FSH level, suggesting its usefulness for predicting ovarian response. However, IVF outcome was not significantly different according to the AMH levels. Serum AMH level presented good cut-off value for poor- or hyper-responders, therefore it could be useful in prediction of cycle cancellation, gonadotropin dose, and OHSS risk in IVF cycles.
키워드 : Anti-müllerian hormone, Ovarian response, Controlled ovarian hyperstimulation
교신저자 : jinkim223@yahoo.co.kr
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