Natural cycle as first approach in aged patients with elevated follicle-stimulating hormone undergoing intracytoplasmic sperm injection: A pilot study

Background.?Poor ovarian response to standard in vitro fertilization–embryo transfer (IVF-ET) protocols or different regimens of treatment, as consequence of a diminished ovarian reserve, correlates strictly with patient age, elevated follicle-stimulating hormone (FSH) and reduced antral follicle count. The aim of the present pilot study was to evaluate the outcome of patients with poor prognostic features undergoing IVF-ET with natural cycles as a first approach and not as a consequence of a previous failure treatment.

Materials and methods.?Eighteen aged patients (mean ± standard deviation 40.2 ± 0.7 years, range 37–43 years) with elevated serum FSH and reduced antral follicle count underwent intracytoplasmic sperm injection (ICSI) after spontaneous ovulation.

Results.?A total of 26 natural cycles with ICSI were analyzed. Pregnancy was observed in three patients, of which two were ongoing as assessed by fetal heart beat at ultrasound scan performed 4–5 weeks after ET.

Conclusion.?The overall pregnancy rates achieved (11.5% per cycle, 20.0% per ET) are comparable with those of conventional IVF-ET in aged patients, and not impaired by a single embryo transferred. Better embryo quality, as a consequence of natural selection of oocytes, better endometrium receptivity and monthly repeatability of the procedure, can balance the relatively low chance to perform ET.     

基础窦卵泡数在评价卵巢的反应性及预测人类辅助生殖技术(ART)结局中的作用

目的:探讨基础总窦卵泡数(tAFC)在评价卵巢功能和预测ART结局中的作用。方法:回顾性分析1 353例接受常规体外受精(IVF)/卵母细胞质内单精子显微注射(ICSI)治疗的不孕患者早卵泡期窦卵泡计数的资料,按tAFC分组:A组<5个,B组5~10个,C组11~15个,D组>15个,分别统计各组促性腺激素(Gn)用量、hCG注射日直径≥14 mm卵泡数、获卵数、2原核(2PN)数、可利用胚胎数及妊娠结局。结果:tAFC对卵巢反应性和卵巢储备功能的预测价值优于年龄和基础卵泡刺激素(bFSH),tAFC<10个预示卵巢低反应性,>12个则预示卵巢高反应性;tAFC对ART结局的预测价值稍优于年龄和bFSH,tAFC>10个则预示临床妊娠可能性大,tAFC>15个或<5个则预示周期取消率增加。新鲜周期妊娠率随tAFC增多而上升(C组最高42.3%),周期取消率随tAFC增多而下降,但tAFC>15个时,周期取消率上升至24.2%,主要原因是卵巢过度刺激综合征(OHSS)。结论:基础tAFC与影响ART结局的各种因素密切相关,可作为预测ART结局的参考指标,并且直接有效地评价卵巢储备功能和卵巢反应性,是患者接受ART前的首选检查,临床应用中值得推广。     

The clinical analysis of poor ovarian response in in-vitro-fertilization embryo-transfer among Chinese couples

Purpose To explore the prevalence, predictor of clinical pregnancy and possible aetiology of poor ovarian response (POR) in in vitro fertilization–embryo transfer (IVF–ET) in Chinese. Methods A total of 4,600 retrieval oocyte cycles were finished between July 1, 2004 and April 30, 2006. Poor ovarian responses were observed in 426 patients of 472 cycles undergoing IVF, which were selected on the same retrieve oocyte day as the control group. The outcome of IVF–ET and the common markers of ovarian reserve were compared. Results The patients had previous ovarian surgery in 64 cycles of 472 poor ovarian response cycles. The group with poor ovarian response has significant differences in comparison with the control group in age (36.6 ± 4.2 vs 33.3 ± 4.04), ovarian surgeries (13.6 vs 2.8%), dose of gonadotrophin (58.5 ± 15.8 vs 40.6 ± 17.0), fertilization rate (71.5 vs 86%) and pregnancy rate (14.8 vs 36.7%). In the group with poor ovarian responses, clinical pregnancy rate declined significantly in women aged >40 years than in those aged ≤40 years (2.8 vs 18.5%, P < 0.001). The age, basal serum follicle stimulating hormone (FSH), basal serum luteinizing hormone (LH), basal oestradiol (E2) concentrations, FSH to LH ratio and the antral follicle count (AFC) are the common markers of ovarian reserve in our center. We found that there were significant differences in age, basal FSH, FSH-to-LH ratio and the antral follicle count. But no statistical significant differences were observed in basal oestradiol concentration and basal serum LH when comparing the two groups. Binary logistic regression analysis was used to study the relation among age, FSH, LH, E2, AFC and clinical pregnancy, and the age (odds ratio, 0.863; 95% confidence interval, 0.805–0.925; p = 0.000) was the only variable selected. Conclusion Our data show that the prevalence of poor ovarian response in Chinese is 11.9%. Previous ovarian surgery is associated with poor ovarian responses. The pregnancy rate of women with poor ovarian response is low in IVF–ET, especially the decline in clinical pregnancy rate of women aged >40 years became accelerated. Correct identification of those who are at risk for POR prior to stimulation is helpful in tailoring the best stimulation protocol to individual patients. Chronological age significantly improved the prediction of clinical pregnancy of poor ovarian responders.     

Clinical usefulness of basal FSH as a prognostic factor in patients undergoing intracytoplasmic sperm injection

OBJECTIVE: To determine if basal serum follicle stimulating hormone (FSH) level could be a prognostic factor of the clinical outcome in intracytoplasmic sperm injection (ICSI) cycles in the couples with male factor infertility. MATERIALS AND METHODS: From December 1995 to March 1998, total 118 patients underwent in vitro fertilization and embryo transfer (IVF-ET) with ICSI due to male factor infertility were included in this study. Patients were allocated to the low basal FSH group (< 8.5 mIU/ml) and the high basal FSH group (> or = 8.5 mIU/ml). The basal levels of FSH were measured in the 3rd day of menstrual cycle preceding ovarian stimulation cycle in total IVF cycles by immunoradiometric assay (IRMA). Statistical analysis was performed using Student's t-test, Fisher's exact test, and chi 2 test as appropriate. Statistical significance was defined as p < 0.05. RESULTS: The total dose of exogeneous gonadotropin required in the high basal FSH group was significantly higher than that in the low basal FSH group. The numbers of retrieved oocytes and oocytes with grade I, II were significantly higher in the low basal FSH group. The clinical pregnancy rate per cycle in the low basal FSH group (16.2%) was significantly higher than that in the high basal FSH group (4.0%). CONCLUSION: These results suggested that the basal serum FSH levels could be predictive of pregnancy outcome and the results of controlled ovarian hyperstimulation (COH) in ICSI cycles.     

脱氢表雄酮在卵巢储备功能低下高龄患者体外受精/卵胞质内单精子注射-胚胎移植中的应用研究

目的探讨口服脱氢表雄酮(DHEA)辅助治疗在卵巢储备功能低下(DOR)高龄患者体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)中的临床疗效。方法选取行IVF/ICSI助孕治疗的DOR患者152例,所有患者均行2次及以上助孕周期,前一周期为未加用药周期(治疗前组),本次为用药周期(治疗后组),进行自身用药前后对照分析。比较口服DHEA后卵巢储备功能的变化情况,同时比较是否加用DEHA患者IVF/ICSI-ET的临床治疗参数、实验室参数及临床结局。结果 (1)口服DHEA后患者血清抗苗勒管激素(AMH)、硫酸脱氢表雄酮(DHEA-s)、睾酮(T)及窦卵泡计数(AFC)较用药前升高,卵泡刺激素(FSH)较前下降,差异有统计学意义(P0.05);(2)治疗后组h CG注射日E2及孕酮(P)水平、获卵数、受精率、可移植胚胎数、胚胎种植率及临床妊娠率高于治疗前组,Gn总用量、Gn使用时间、周期取消率低于治疗前组,差异有统计学意义(P0.05)。结论 DOR的高龄患者在进入IVF/ICSI周期前口服DHEA可改善其卵巢储备功能及助孕结局。     

Recombinant follicle-stimulating hormone versus human menopausal gonadotropin in the late follicular phase during ovarian hyperstimulation for in vitro fertilization

OBJECTIVE: To study the effect of exogenous LH in the late follicular phase on ongoing pregnancies and at the different stages of IVF-ET (stimulation, fertilization, and implantation) in patients with low endogenous LH. DESIGN: Retrospective cohort study with modeling of the different phases of IVF-ET. SETTING: IVF center of the teaching hospital in Bordeaux, France. PATIENT(S): Women undergoing IVF and ICSI treatment. INTERVENTION(S): One group received recombinant FSH alone (FSH group) and the other received recombinant FSH and hMG in the late follicular phase (i.e., when the largest follicle reached 14 mm) (FSH/hMG group). MAIN OUTCOME MEASURE(S): Ongoing pregnancy, number of oocytes, and number of embryos.RESULT(S): The FSH/hMG group had a higher probability of having at least one oocyte (odds ratio [OR] = 2.75 [1.11-6.80]), of having at least one embryo after oocyte retrieval (OR = 2.84 [1.33-6.07]), and of ongoing pregnancy after ET (OR = 2.04 [0.83-5.01]), and globally had a higher probability of ongoing pregnancy (OR = 2.83 [1.19-6.71]). CONCLUSION(S): In ovarian hyperstimulation for IVF-ET, LH supplementation in the late follicular phase of women with low endogenous LH is beneficial for ongoing pregnancy by increasing the rate of success of all stages of the treatment.     

窦卵泡计数及卵巢动脉血流变化与助孕术治疗结局的关系探讨

目的:探讨助孕术前子宫、卵巢的血流动力学变化及窦卵泡数与IVF-ET治疗后妊娠结局的关系。方法:129例拟采用IVF-ET助孕技术治疗的不育症患者,经阴道彩色多谱勒分别检测子宫体积、内膜厚度、血液动力学变化和卵巢体积、血液动力学以及窦卵泡数,比较分析上述指标与IVF-ET后成功妊娠的关系。结果:妊娠成功组的卵巢基质血流PI及RI、S/D指标显著小于妊娠失败组,而卵巢体积、窦卵泡数显著大于妊娠失败组,但是妊娠与否与子宫的相关参数无关。结论:卵巢动脉的PI、RI、S/D、卵巢体积和窦卵泡数数与妊娠结局有密切的关系。     

Antral follicle counts by transvaginal ultrasonography are related to age in women with proven natural fertility

OBJECTIVE: To investigate the relation between reproductive age and ultrasound (US)-based follicle counts and the reproducibility of follicle counts in regularly cycling women with proven fertility. DESIGN: Prospective observational study. SETTING: Tertiary fertility center. PATIENT(S): Healthy female volunteers with proven fertility, recruited by advertisement in local newspapers. INTERVENTION(S): The number of antral follicles sized 2-10 mm and ovarian volume were estimated by transvaginal US in the early follicular phase of the menstrual cycle in 162 women. A subgroup of 81 women underwent transvaginal US at several times in three subsequent cycles. MAIN OUTCOME MEASURE(S): Antral follicle count and total ovarian volume. RESULT(S): Women aged 25-46 years (n = 162) were studied. The relation of age with the US indices was computed after natural log transformation. Antral follicle count showed the clearest correlation with age (R = -0.67). A biphasic linear model gave the best fit to the data. Before the age of 37 years, the antral follicle count showed a mean yearly decline of 4.8%, compared with 11.7% thereafter. The reproducibility of the antral follicle count in two subsequent cycles was moderate. CONCLUSION(S): The number of small antral follicles in both ovaries as measured by US is clearly related to reproductive age and could well reflect the size of the remaining primordial follicle pool.     

Ovarian changes after abdominal hysterectomy for benign conditions

OBJECTIVES: To investigate any change in the ovaries, including early follicular serum follicle-stimulating hormone (FSH) level, total ovarian volume, total antral follicle count, and ovarian stromal blood flow, in patients who had undergone abdominal hysterectomy for benign conditions. METHODS: Fifteen women with abdominal hysterectomy and conservation of ovaries for benign conditions and who were between 29 and 44 years old were recruited to undergo three-dimensional ultrasound examination with power Doppler to assess total ovarian volume, total antral follicle count, and vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of ovarian stromal blood flow. Serum FSH, estradiol, and progesterone levels were checked on the same day. The results of the assessments were considered taken during the early follicular phase if the estradiol and progesterone levels were basal. Fifteen age-matched healthy women underwent the same assessments on the second day of menstruation. RESULTS: Women with hysterectomy had significantly elevated serum FSH level and lower ovarian stromal blood flow indices, including VI, FI, and VFI, as compared with healthy women. The total antral follicle count and the total ovarian volume were similar between the two groups. CONCLUSION: These changes may suggest altered ovarian function after hysterectomy.     

Intercycle variabilities of basal antral follicle count and ovarian volume in subfertile women and their relationship to reproductive aging: a prospective study.

BACKGROUND: Reproducibility is an important issue when using tests for estimating ovarian reserve and counseling patients. However, little is known about the intercycle variabilities of basal antral follicle count and ovarian volume. In this prospective study, we analysed the intercycle variabilities of the antral follicle count and ovarian volume, and compared them with those of other basal ovarian reserve tests in subfertile patients. METHOD: Fifty-two ovulatory and infertile women were followed for two consecutive spontaneous cycles. The antral follicle count, ovarian volume, serum follicle stimulating hormone and estradiol levels were determined on day 3 of both cycles. Limits of agreement between two measurements were determined. RESULTS: Limits of agreement were -6.9 and 6.5 for the antral follicle count, and -8.3 and 8.6 for the ovarian volume. These degrees of variation corresponded to a range of 1.30 and 1.45 times their means for the ovarian volume and antral follicle count, respectively. The variability in the antral follicle count was greater in women who were younger than 24.5 years than in those who were older. CONCLUSIONS: Intercycle variabilities of the antral follicle count and ovarian volume were clinically significant. More variation was observed in the antral follicle count of young infertile patients. Therefore, a low antral follicle count in young, infertile, but ovulatory women should be cautiously interpreted. This may not reflect a low ovarian reserve, and these women may have a high antral follicle count in the next cycle.     

CLINICAL ASSISTED REPRODUCTION: Determination of the Efficiency of Controlled Ovarian Hyperstimulation in the Gonadotropin-Releasing Hormone Agonist-Suppression Cycle Using the Initial Follicle Count During Gonadotropin Stimulation

Purpose: Our purpose was to evaluate the relationship between the initial follicle count during gonadotropin stimulation after gonadotropin-releasing hormone (GnRH) agonist suppression and the efficiency of controlled ovarian hyperstimulation (COH) in patients receiving treatment with assisted reproductive technologies (ARTs).Methods: A total of 338 COH procedures in 291 couples was performed with cycles that reached the stage of oocyte retrieval. The ovarian antral follicle number was measured using transvaginal ultrasonography at the folliculometry during gonadotropin stimulation by GnRH agonist suppression in patients undergoing ARTs. Controlled ovarian hyperstimulation was accomplished using GnRH agonist down-regulation combined with FSH and menotropin stimulation. The characteristics of oocytes after retrieval and embryos after in vitro culture and the pregnancy rates were assessed.Results: The procedures performed included 195 ET cycles, 129 TET cycles, and 14 incomplete cycles. The treatment cycles were divided into four categories according to the antral follicle number (i.e., 5, 6–10, 11–15, and 16) at the first folliculometry to evaluate the influence of various factors. The antral follicle count correlated significantly with the patient age, dosage of gonadotropins, serum estradiol concentration, number of antral follicles (13 mm) while receiving hCG injections, number of oocytes retrieved, and, later, number of embryos transferred. There was a trend toward an increasing number of pregnancies per cycle as the number of antral follicles increased (14.7, 26.5, 44, and 45%, respectively).Conclusions: We were able to predict the efficiency of COH and outcome of ARTs based on the follicle count during the first folliculometry during gonadotropin stimulation after GnRH agonist suppression. The results of the folliculometry significantly predicted the ovarian response to COH and the outcome of ARTs in the current treatment cycle.     

Minimal stimulation using recombinant follicle-stimulating hormone and a gonadotropin-releasing hormone antagonist in women of advanced age

OBJECTIVE: To determine whether minimal stimulation with short-term application of low-dose recombinant follicle-stimulating hormone (FSH) together with a gonadotropin-releasing hormone (GnRH) antagonist represents a cost-effective treatment regimen for patients with elevated FSH levels, aged 40 and above. DESIGN: Retrospective cohort study. SETTING: Academically affiliated private in vitro fertilization (IVF) program. PATIENT(S): Eighty-five IVF cycles using minimal ovarian stimulation and 85 cycles with a standard long-stimulation protocol, conducted between January 2000 and January 2002, in women aged 40 and above who had slightly increased FSH levels. INTERVENTION(S): Patients on the long protocol underwent standard cycle monitoring and stimulation. In contrast, women with minimal stimulation had transvaginal sonography initiated on day 8 of the menstrual cycle and at a follicle size of 13 mm. We administered 0.25 mg of GnRH antagonist and 75 IU recombinant FSH daily until ovulation induction. MAIN OUTCOME MEASURE(S): Numbers of oocytes, and rates of cancellation and pregnancy. RESULT(S): Minimal stimulation cycles resulted in a clinical pregnancy rate of 8.2% per started cycle and 10% per embryo transfer (ET), whereas the control group yielded a clinical pregnancy rate of 10.6% per started cycle and of 10.7% per ET (not statistically significant). CONCLUSION(S): In women aged 40 and above with abnormal FSH levels, minimal stimulation protocol achieves similar pregnancy rates to a standard protocol, and thus represents a cost-effective alternative.     

Basal antral follicle number and mean ovarian diameter predict cycle cancellation and ovarian responsiveness in assisted reproductive technology cycles

OBJECTIVE: To determine the predictive value and define threshold levels for basal antral follicle number and mean ovarian diameter in patients undergoing ART cycles. DESIGN: Retrospective. SETTING: Tertiary care center. PATIENTS: Two hundred seventy-eight patients who had ovarian measurements performed on cycle day 3 before beginning treatment with gonadotropins. INTERVENTION: Pretreatment ovarian ultrasound measurements. MAIN OUTCOME MEASURE: Number of oocytes retrieved, hormone levels, and cycle outcomes. RESULTS: A direct linear correlation was observed between mean ovarian diameter and basal follicle number. Both measures demonstrated a positive linear correlation with recovered oocytes, basal E(2), and peak E(2). Both demonstrated a negative linear correlation with ampules of gonadotropins administered, days of stimulation, patient age, cycle day 3 FSH, and FSH:LH ratio. An antral follicle count of 相似文献   

The impact of autoimmunity-related early ovarian aging on ICSI cycle outcome

Abstract

The aim of this study was to investigate the impact of anti-thyroid peroxidase antibodies (Anti-TPO) on the in vitro fertilization and embryo transfer (IVF-ET) outcome in women with poor ovarian reserve but normal thyrotropin levels. A total of 300 patients with poor ovarian reserve undergoing ICSI cycle from April 2015 to December 2017 were analyzed retrospectively. Subjects were divided into two groups: Group 1: Women with early ovarian aging, Group 2: Women with age related poor ovarian reserve. All subjects underwent anti-thyroid peroxidase antibody (anti-TPO) analysis. The impacts of age and anti-TPO positivity on cycle outcome were assessed. There were no significant differences in basal FSH, basal AMH levels, and antral follicle count between the two main groups. Groups were also comparable in terms of the duration of ovarian stimulation, peak estradiol level, starting gonadotropin dose, total gonadotropin dose, and number of oocytes retrieved. Clinical pregnancy and cycle cancelation rates were significantly higher in group with age-related poor ovarian reserve. While autoimmune thyroid disease rate was significantly higher in group with early ovarian aging. Anti-TPO positivity was a risk factor for poor cycle outcome [RR: 2.8 (95% CI: 1.2–6.3)]. Early ovarian aging may be associated with poorer cycle outcome compared to group with age-related poor ovarian reserve. This difference may be associated with high rate of autoimmunity which led to the impaired endometrial receptivity.     

Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles

Objective  

To evaluate predictive role of day–3 serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) in ovarian hyperstimulation syndrome (OHSS) in patients undergoing IVF/ICSI cycles.     

Young patients with diminished ovarian reserve undergoing assisted reproductive treatments: a preliminary report

Young assisted-reproduction patients with diminished ovarian reserve (DOR) are one of the most challenging issues for IVF specialists. A retrospective study of 70 assisted reproduction patients younger than 35 years with DOR determined based on antral follicle count was conducted, investigating: (i) correlation of day 3 FSH measurement with antral follicle count; and (ii) cycle outcome of young DOR patients compared with 53 young assisted reproduction patients with normal ovarian reserve (NR). DOR was considered as antral follicle count of <6 per ovary. Day 3 FSH in the DOR group was significantly higher than in the NR group (8.3 and 6.6 mIU/ml respectively; P < 0.05). Implantation rates between the groups were similar (15% in DOR and 18% in NR). Pregnancy rate was 35.8% in the DOR group, significantly lower than that of the NR group, which was 54.7% (P = 0.028). Although the pregnancy rate was significantly lower in the DOR group compared with the NR group, the statistically insignificant difference in implantation rates demonstrated that the problem in young DOR patients was mainly the number of retrieved oocytes. Therefore, such couples should be informed that lower oocyte numbers will result in statistically lower, but still encouraging, pregnancy rates. Basal FSH should also be measured during evaluation as an adjunct to antral follicle count.     

Impact of repeated antral follicle counts on the prediction of poor ovarian response in women undergoing in vitro fertilization

OBJECTIVE: To study the value of a single antral follicle count and the additional value of repeated counts in different cycles for the prediction of poor ovarian response in IVF. DESIGN: Prospective. SETTING: Tertiary fertility center. PATIENT(S): One hundred twenty women undergoing their first IVF cycle. INTERVENTION(S): Measurement of the number of antral follicles on cycle day 3 in two spontaneous cycles.Ovarian response. RESULT(S): A single antral follicle count is clearly predictive of poor ovarian response and there is good agreement between repeated measurements in subsequent cycles (area under the receiver operating characteristic curve [ROC(AUC)]; cycle 1: 0.87, cycle 2: 0.85). In a logistic regression analysis, information obtained after the second cycle contributed significantly to the prediction of poor response by the antral follicle count of the first cycle. The predictive accuracy of the highest of two counts (ROC(AUC) 0.89) was slightly better than that of each single count. The predictive model with the highest count yielded slightly higher values of specificity and positive predictive value. Sensitivity, negative predictive value, and error rates were slightly lower. CONCLUSION(S): A single antral follicle count is a good predictor of poor ovarian response in IVF. Although the impact of a second antral follicle count on ovarian response predictions in IVF is statistically significant, clinical relevance is very limited. Repeating an antral follicle count in a subsequent cycle is not recommended.     

Prediction of pregnancy in IVF cycles on the fourth day of ovarian stimulation

Purpose Prediction of IVF outcome on the first days of ovarian stimulation has focused clinical research for many years. The aim of this work is to predict the probability of pregnancy on the fourth day of ovarian stimulation for IVF cycle, using parameters usually determined in this stage—estradiol, antral follicle count—together with parameters determined previously: FSH on the third day of cycle and women age. Materials and methods One hundred and ten patients with primary infertility due to a tubal factor were recruited to participate in a prospective study. FSH was determined on the third day of spontaneous cycle. Antral follicles and estradiol were measured on the fourth day of ovarian stimulation. After oocyte pick-up, quality and quantity of oocytes and embryos and pregnancy rates were assessed. Results In stepwise multiple logistic regression the variables with better predictiveness over pregnancy are: antral follicles count, estradiol and woman age. The logistic regression analyses demonstrate that the capacity of the model that uses these variables to predict pregnancy is 75%, with a positive predictive value of 69% and a negative predictive value of 80%. Conclusions On the fourth day of ovarian stimulation of IVF cycles, the variables with highest predictiveness are: antral follicle count, estradiol and women age. When these variables are included in a model of prediction, the capacity to predict pregnancy is 75%. On the fourth day of ovarian stimulation for IVF cycles, antral follicles count, estradiol and woman age predict IVF outcome as reflected by quantity and quality of oocytes, embryos obtained and pregnancy rates.     

促性腺激素释放激素激动剂降调节后血清抑制素B水平对体外受精-胚胎移植结局的预测价值

目的 探讨促性腺激素释放激素激动剂(GnRH-a)降调节后,血清抑制素B(INHB)对体外受精-胚胎移植(IVF-ET)中卵巢反应性和IVF-ET结局的预测价值.方法 前瞻性观察124例行IVF-ET患者.超促排卵均采用GnRH-a+重组卵泡刺激素(rFSH)+人绒毛膜促性腺激素(hCG)黄体期长方案.观察指标:年龄、基础卵泡刺激素(bFSH)水平、卵泡刺激素(FSH)与黄体生成素(LH)比值、GnRH-a降调节后INHB水平、双侧卵巢内总窦卵泡数(AFC)及双侧卵巢体积.卵巢反应性评价指标为获卵数.通过多元线性回归分析、logistic同归分析评价各激素水平与卵巢反应性及IVF-ET结局的关系,计算受试者工作特征(ROC)曲线下面积(AUC),评价INHB水平预测获卵数的准确率,通过敏感度、特异度计算并确定其诊断临界值.结果 INHB水平与AFC呈显著正相关关系(r=0.435,P<0.01);多元回归分析显示,INHB水平与bFSH水平呈显著负相关关系(r=-0.239,P<0.01),与AFC(r=0.435,P<0.01)、获卵数(r=0.861,P<0.01)呈显著正相关关系,而与年龄、FSH/LH比值、卵巢体积无相关性(P>0.05).ROC曲线分析显示,GnRH-a降调节后,INHB水平的最大AUC为0.933(95%CI为0.878～0.988),将INHB水平为15 ng/L作为临界值时,其预测卵巢反应性的敏感度为95.5%,特异度为50.0%.结论 INHB水平足预测IVF-ET中卵巢反应性的最佳指标之一,INHB水平下降是卵巢储备功能下降的早期指标,但对IVF-ET结局无预测价值.     

Intercycle variabilities of basal antral follicle count and ovarian volume in subfertile women and their relationship to reproductive aging: A prospective study

Background.?Reproducibility is an important issue when using tests for estimating ovarian reserve and counseling patients. However, little is known about the intercycle variabilities of basal antral follicle count and ovarian volume. In this prospective study, we analysed the intercycle variabilities of the antral follicle count and ovarian volume, and compared them with those of other basal ovarian reserve tests in subfertile patients.

Method.?Fifty-two ovulatory and infertile women were followed for two consecutive spontaneous cycles. The antral follicle count, ovarian volume, serum follicle stimulating hormone and estradiol levels were determined on day 3 of both cycles. Limits of agreement between two measurements were determined.

Results.?Limits of agreement were –?6.9 and 6.5 for the antral follicle count, and –?8.3 and 8.6 for the ovarian volume. These degrees of variation corresponded to a range of 1.30 and 1.45 times their means for the ovarian volume and antral follicle count, respectively. The variability in the antral follicle count was greater in women who were younger than 24.5 years than in those who were older.

Conclusions.?Intercycle variabilities of the antral follicle count and ovarian volume were clinically significant. More variation was observed in the antral follicle count of young infertile patients. Therefore, a low antral follicle count in young, infertile, but ovulatory women should be cautiously interpreted. This may not reflect a low ovarian reserve, and these women may have a high antral follicle count in the next cycle.