国际生殖健康/计划生育 ›› 2018, Vol. 37 ›› Issue (6): 454-457.

• 论著 • 上一篇    下一篇

提高卵巢功能正常患者促排卵治疗卵巢反应性预测准确率:一项诊断试验研究

何艺磊,杨硕,徐慧玉,李蓉,乔杰   

  1. 100191  北京大学第三医院妇产科
  • 收稿日期:2018-05-17 修回日期:2018-09-24 出版日期:2018-11-15 发布日期:2018-11-15
  • 通讯作者: 李蓉,E-mail:roseli001@sina.com E-mail:roseli@163.com

Improving the Prediction of Ovarian Response to Ovulation Induction in Patients with Normal Ovarian Function: A Diagnostic Trial

HE Yi-lei,YANG Shuo,XU Hui-yu,LI Rong,QIAO Jie   

  1. Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China
  • Received:2018-05-17 Revised:2018-09-24 Published:2018-11-15 Online:2018-11-15
  • Contact: LI Rong,E-mail:roseli001@sina.com E-mail:roseli@163.com

摘要: 目的:探讨促排卵治疗中卵巢反应性预测准确率较高的指标。方法:回顾性分析2014年6月—2016年12月于北京大学第三医院生殖医学中心实施体外受精/胞浆内单精子注射(IVF/ICSI)治疗患者的基本信息、用药情况及治疗结局,共5 859个IVF/ICSI周期,用于建立Logistic回归模型预测卵巢反应性,其中低反应组517个周期,正常反应组4 061个周期,高反应组1 281个周期。2017年1—12月患者的临床资料共1 143个周期作为诊断试验用于验证。结果:3组的年龄、窦卵泡数(AFC)、基础血清激素水平、促排卵药物使用情况及临床结局差异均有统计学意义(P<0.001)。血清抗苗勒管激素(AMH)是卵巢反应性的重要预测因素,预测高反应及低反应Cut-off值分别为2.76 ng/mL、1.50 ng/mL,结合年龄可更好地预测卵巢高反应,参考AFC可预测卵巢低反应的发生。结论:血清AMH是促性腺素(Gn)启动前预测卵巢反应性较好的指标,联合AFC和年龄对取得适当数量卵细胞、获得良好的妊娠结局及预防卵巢过度刺激综合征具有较大意义。

关键词: 排卵诱导, 受精, 体外, 精子注射, 细胞质内, 抗苗勒管激素, 卵巢反应性

Abstract: Objective:To investigate the high-accuracy predictive factors of ovarian response to ovulation induction. Methods:The basic information, medication and outcome of 5 859 IVF/ICSI cycles were respectively analyzed in our center from June 2014 to December 2016. The Logistic regression model was developed to predict the ovarian response. There were a total of 517 cycles in the low-response group, 1 281 cycles in the high-response group and 4 061 cycles in the normal-response group. The clinical data of 1 143 cycles in 2017 were used to test the diagnostic value of those factors. Results:The differences in the age, AFC, basal hormone levels, medication and clinical outcomes were significant among the three groups (P<0.001). The level of serum AMH was the important predictor of ovarian response, with the cut-off values of 2.76 ng/mL for high ovarian response and 1.50 ng/mL for low ovarian response. AMH if combining with age could predict high ovarian response, while AMH combining with AFC also predict low ovarian response. Conclusions:The level of serum AMH was a good predictor of ovarian response before Gn initiation. AMH if combining with AFC and age was of great significance in obtaining an appropriate number of oocytes, ensuring a good pregnancy outcome and preventing ovarian hyperstimulation syndrome.

Key words: Ovulation induction, Fertilization in vitro, Sperm injections, intracytoplasmic, Anti-Mullerian hormone, Ovarian response