Abstract：
OBJECTIVE: To investigate the relationship between anti-Müllerian hormone (AMH) level and early pregnancy loss in patients who underwent their first embryo transfer by hormone replacement therapy-frozen-thawed embryo transfer (HRT-FET) and analyze the threshold effect.
METHODS: A retrospective cohort analysis was performed on pregnant women undergoing HRT-FET at the Reproductive Medical Center of Henan Provincial People\'s Hospital from January 2016 to December 2021. The patients were divided into four groups based on AMH concentration according to the Poseidon criteria: group A (≤1 μg/L), group B (1-≤2 μg/L), group C (2-≤6 μg/L), and group D (>6 μg/L). Univariate analysis, multivariate logistic regression analysis, smooth curve fitting, and threshold effect analysis were applied to investigate the influence of AMH on the outcome of early pregnancy loss in in vitro fertilization/intracytoplasmic sperm injection and HRT-FET cycles.
RESULTS: Of the 6597 pregnant women, early pregnancy loss occurred in 893, giving an early pregnancy loss rate of 13.54%. Univariate regression analysis demonstrated that age, female body mass index, AMH, antral follicle count, endometrial thickness at endometrial transformation day, total retrieved oocyte number, number of pregnancies, duration of infertility, type of infertility, and the number of embryos transferred were all factors influencing the early pregnancy loss rate (P < 0.050). Multivariate logistic regression analysis, after adjusting for confounders, further stratified the analysis of patients of different ages. With group A as the control group, the results showed that when age was younger than 35 years, the pregnancy loss rates in groups B, C, and D were lower than that in group A, with statistical significance (P < 0.050); when age was 35 years or older, there was no statistically significant difference in outcome indicators between the groups (P > 0.050). A threshold effect analysis revealed that the AMH threshold was 2.83 μg/L. When the AMH concentration was less than 2.83 μg/L, the early pregnancy loss rate decreased significantly with increasing AMH concentration; the early pregnancy loss rate decreased by 21% for each unit increase in AMH (odds ratio 0.79; 95% confidence interval 0.71-0.88; P < 0.001); when the AMH concentration was 2.83 μg/L or more, there was no statistical difference in the change in early pregnancy loss rate (odds ratio 1.01; 95% confidence interval 0.99-1.03; P = 0.383).
CONCLUSIONS: For pregnant women after their first embryo transfer, there is a curvilinear relationship between the influences of AMH levels on early pregnancy loss rates in patients younger than 35 years. When the AMH level was less than 2.83 μg/L, the early pregnancy loss rate declined significantly with increasing AMH levels.
METHODS: A retrospective cohort analysis was performed on pregnant women undergoing HRT-FET at the Reproductive Medical Center of Henan Provincial People\'s Hospital from January 2016 to December 2021. The patients were divided into four groups based on AMH concentration according to the Poseidon criteria: group A (≤1 μg/L), group B (1-≤2 μg/L), group C (2-≤6 μg/L), and group D (>6 μg/L). Univariate analysis, multivariate logistic regression analysis, smooth curve fitting, and threshold effect analysis were applied to investigate the influence of AMH on the outcome of early pregnancy loss in in vitro fertilization/intracytoplasmic sperm injection and HRT-FET cycles.
RESULTS: Of the 6597 pregnant women, early pregnancy loss occurred in 893, giving an early pregnancy loss rate of 13.54%. Univariate regression analysis demonstrated that age, female body mass index, AMH, antral follicle count, endometrial thickness at endometrial transformation day, total retrieved oocyte number, number of pregnancies, duration of infertility, type of infertility, and the number of embryos transferred were all factors influencing the early pregnancy loss rate (P < 0.050). Multivariate logistic regression analysis, after adjusting for confounders, further stratified the analysis of patients of different ages. With group A as the control group, the results showed that when age was younger than 35 years, the pregnancy loss rates in groups B, C, and D were lower than that in group A, with statistical significance (P < 0.050); when age was 35 years or older, there was no statistically significant difference in outcome indicators between the groups (P > 0.050). A threshold effect analysis revealed that the AMH threshold was 2.83 μg/L. When the AMH concentration was less than 2.83 μg/L, the early pregnancy loss rate decreased significantly with increasing AMH concentration; the early pregnancy loss rate decreased by 21% for each unit increase in AMH (odds ratio 0.79; 95% confidence interval 0.71-0.88; P < 0.001); when the AMH concentration was 2.83 μg/L or more, there was no statistical difference in the change in early pregnancy loss rate (odds ratio 1.01; 95% confidence interval 0.99-1.03; P = 0.383).
CONCLUSIONS: For pregnant women after their first embryo transfer, there is a curvilinear relationship between the influences of AMH levels on early pregnancy loss rates in patients younger than 35 years. When the AMH level was less than 2.83 μg/L, the early pregnancy loss rate declined significantly with increasing AMH levels.
摘要：
目的：探讨激素替代疗法-冻融胚胎移植（HRT-FET）首次胚胎移植患者抗苗勒管激素（AMH）水平与早孕丢失的关系，并分析阈值效应。
方法：对2016年1月至2021年12月河南省人民医院生殖医学中心行HRT-FET的孕妇进行回顾性队列分析。根据波塞冬标准，根据AMH浓度将患者分为四组：A组（≤1μg/L），B组（1-≤2μg/L），C组（2-≤6μg/L），D组(>6μg/L)。单变量分析,多变量逻辑回归分析，平滑曲线拟合，应用阈值效应分析探讨AMH对体外受精/卵胞浆内单精子注射和HRT-FET周期早期妊娠丢失结局的影响。
结果：在6597名孕妇中，早期妊娠丢失发生893例，早期妊娠丢失率为13.54%。单因素回归分析表明，年龄，女性体重指数,AMH,窦卵泡计数,子宫内膜转化日子宫内膜厚度，检索到的卵母细胞总数，怀孕次数,不孕的持续时间，不孕症的类型，胚胎移植数均是影响早期妊娠丢失率的因素(P<0.050)。多因素Logistic回归分析，在调整了混杂因素后，进一步对不同年龄段患者进行分层分析。以A组为对照组,结果显示，当年龄小于35岁时，B组的妊娠损失率，C,D组低于A组,有统计学意义(P<0.050);当年龄在35岁或以上时,两组间结局指标差异无统计学意义(P>0.050)。阈值效应分析表明，AMH阈值为2.83μg/L。当AMH浓度小于2.83μg/L时,随着AMH浓度的增加，早期妊娠损失率显着降低；AMH每增加一个单位，早期妊娠损失率降低21％（比值比0.79；95％置信区间0.71-0.88；P<0.001）；当AMH浓度为2.83μg/L以上时，早期妊娠丢失率的变化无统计学差异(比值比1.01;95%置信区间0.99-1.03;P=0.383).
结论：对于首次胚胎移植后的孕妇，AMH水平对35岁以下患者早期妊娠损失率的影响之间存在曲线关系.当AMH水平小于2.83μg/L时，随着AMH水平的升高,早期妊娠损失率显著下降.
方法：对2016年1月至2021年12月河南省人民医院生殖医学中心行HRT-FET的孕妇进行回顾性队列分析。根据波塞冬标准，根据AMH浓度将患者分为四组：A组（≤1μg/L），B组（1-≤2μg/L），C组（2-≤6μg/L），D组(>6μg/L)。单变量分析,多变量逻辑回归分析，平滑曲线拟合，应用阈值效应分析探讨AMH对体外受精/卵胞浆内单精子注射和HRT-FET周期早期妊娠丢失结局的影响。
结果：在6597名孕妇中，早期妊娠丢失发生893例，早期妊娠丢失率为13.54%。单因素回归分析表明，年龄，女性体重指数,AMH,窦卵泡计数,子宫内膜转化日子宫内膜厚度，检索到的卵母细胞总数，怀孕次数,不孕的持续时间，不孕症的类型，胚胎移植数均是影响早期妊娠丢失率的因素(P<0.050)。多因素Logistic回归分析，在调整了混杂因素后，进一步对不同年龄段患者进行分层分析。以A组为对照组,结果显示，当年龄小于35岁时，B组的妊娠损失率，C,D组低于A组,有统计学意义(P<0.050);当年龄在35岁或以上时,两组间结局指标差异无统计学意义(P>0.050)。阈值效应分析表明，AMH阈值为2.83μg/L。当AMH浓度小于2.83μg/L时,随着AMH浓度的增加，早期妊娠损失率显着降低；AMH每增加一个单位，早期妊娠损失率降低21％（比值比0.79；95％置信区间0.71-0.88；P<0.001）；当AMH浓度为2.83μg/L以上时，早期妊娠丢失率的变化无统计学差异(比值比1.01;95%置信区间0.99-1.03;P=0.383).
结论：对于首次胚胎移植后的孕妇，AMH水平对35岁以下患者早期妊娠损失率的影响之间存在曲线关系.当AMH水平小于2.83μg/L时，随着AMH水平的升高,早期妊娠损失率显著下降.
