抗穆勒氏荷爾蒙及排卵誘導藥物對於
試管嬰兒懷孕率的影響

摘要背景：低生育率是現在政府要積極推動改善的目標，部分父母是因為工作、經濟壓力而不願意生產，但是有一部分的父母卻是為不孕而苦。近年來不孕症的病人已有增多的現象，慢慢地已成為現在重要的社會問題了。不孕症的治療在全民健康保險上是不給付的，所以往往在療程上就必須花費不少的金錢，因此如何選擇適當又有效的藥品是我們主要討論的目的，藉此也希望可以讓不孕症的病人省下一筆治療的花費。方法：本研究是病歷回溯型研究，於2009年12月~2011年2月，收入台灣某區域教學醫院生殖醫學中心，年齡介於24至44歲之病人，須檢測抗穆勒氏荷爾蒙 ( Anti-Müllerian hormone，AMH ) 之試管嬰兒療法之病人，共60人進行研究。統計分析比較AMH值與懷孕率是否有相關性。有無使用藥品Leuprolide® , Supremon®【促性腺刺激素類似劑或作用劑( Gonadotropin releasing hormone analogues or agonists, GnRHa）】和懷孕率結果之相關性。幫助濾泡成長的藥品Gonal-F®【濾泡刺激素( Follicle stimulating hormone，FSH )】的使用劑量與懷孕率是否有相關性? 有無使用藥品Merional®【人類停經期促性腺激素( Human menopausal gonadotropins, HMG )】和懷孕率結果之相關性。結果：研究發現AMH ≧ 3.20 ng/mL與AMH ＜ 3.20 ng/mL施行試管嬰兒不孕症病人，其懷孕率有顯著性差異，p = 0.047，AMH ≧ 3.20 ng/mL有38.10％的不孕症病人懷孕，而AMH ＜ 3.20 ng/mL的不孕症病人有15.38％懷孕。試管嬰兒治療中有無使用GnRHa ( Leuprolide® , Supremon® ) 及Merional® 對於其懷孕率無顯著性的差異（分別為p = 0.170 和 p = 0.222）。 AMH和Gonal-F® 使用的劑量呈顯著性負相關( p = 0.049 )，做出散佈圖且得到線性方程式: Gonal-F® 使用總劑量= - 81.841 x AMH值 + 2477.1，R2 = 0.1533。在散佈圖中，若醫師開立的Gonal-F® 總劑量落於此方程式之上的病人，其懷孕率有37.50％，而醫師開立的Gonal-F® 總劑量落於此方程式之下的病人其懷孕率有13.89％，兩者的懷孕率具統計上的顯著性差異( p = 0.034 )。結論： AMH ≧ 3.20 ng/mL可為預測懷孕率的參考指標，Gonal-F® 使用總劑量落於Gonal-F® 總劑量之方程式之上也可獲得較佳的懷孕率。此研究結果可成為試管嬰兒治療的一個參考方向。

關鍵字

試管嬰兒；懷孕率； FSH ； AMH

並列摘要

Abstract Background: The low birth rate problem is a current target that the government in Taiwan would like to address and resolve. Although part of this problem may due to economic pressure that delay childbirth of some parents because they have to work, however, for other parents, the problem is due solely to infertility. Infertility rate in Taiwan has increased in recent years and has slowly become an important social issue. Infertility treatment is not covered by the National Health Insurance in Taiwan. The medical examinations and treatment of infertility is very complex and also very expensive. The main purpose of this study is to discuss how to select the right medications, the appropriate dosages for enhancing the pregnancy rate, thereby lowering the cost for a patient undergoing an infertility treatment. Method: This is a retrospective study. From December 2009 to February 2011, we investigated a total of 60 patients aged 24 - 44 years old who have undergone in vitro fertilization ( IVF ) treatment at Center for Reproductive Medicine of a regional teaching hospital in Taiwan. We observed and correlated patient’s Anti-Müllerian hormone ( AMH ) and with their pregnancy outcome, and also correlate Leuprolide® , Supremon® ( Gonadotropin-stimulating hormone analogues, GnRHa ), and Gonal-F® ( Follicle-stimulating hormone, FSH ) correlation with pregnancy outcome, Merional® ( Human menopausal gonadotropin, HMG ) was investigated. Results: This study showed better predictive value of AMH for pregnancy was more or equal to 3.20 ng/mL ( p = 0.047, compared with AMH level were less than 3.20 ng/mL ). When AMH more or equal to 3.20 ng/mL approximately 38.10% of infertility patients will have a successful pregnancy whileas if AMH level were less than 3.20 ng/mL, pregnancy rate dropped to 15.38%. There were no significant differences in IVF treatment with used GnRHa ( Leuprolide® , Supremon® ) and used Merional® for pregnancy( p = 0.170 vs p = 0.222 ). There were negative correlations between AMH level and total doses of Gonal-F® used. The linear equation was Gonal-F® total dose = - 81.841x AMH value + 2477.1, R2 = 0.1533, if the cases of total doses of Gonal-F® used was above the point in the equation, the pregnancy rate was 37.50%, if it was below in the equation, the pregnancy rate was 13.89 % ( p = 0.034 ). Conclusions: AMH level more or equal to 3.20 ng/mL can be used to predict a higher pregnancy rate for the IVF patients. It can also be used to convert to total dose of Gonal-F® by the equation, thereby improving IVF pregnancy rates and save unnecessary medication costs.