Age-related changes in ovarian volume, antral follicle counts and basal follicle stimulating hormone levels: comparison between fertile and infertile women.

Our objective was to compare the relationship between age, basal follicle stimulating hormone (FSH) level and ultrasound-measured mean ovarian volume (MOV) and mean antral follicle counts (MFC) in a group of infertile and fertile women between the ages of 35 and 45 years. Menstrual cycle day 3 serum FSH, MOV and MFC were analyzed in 62 infertile and 53 fertile women. Basal FSH and MFC did not differ between infertile and fertile women, whereas MOV was significantly smaller in infertile women (p < 0.05). In the infertile group, there was a negative correlation between MOV and age (rho = -0.389, p < 0.05), between MOV and basal FSH (rho = 0.495, p < 0.01), and between MFC and age (rho = -0.553, p < 0.01). In the fertile group, there was a strong negative correlation between MOV and basal FSH (rho = -0.631, p < 0.01), and between MFC and basal FSH (rho = -0.710, p < 0.01). Mean basal FSH, MOV and MFC did not differ between subgroups of patients with different causes of infertility. In the infertile group, patients with small ovaries of volume less than 1.8 cm(3) (mean volume -1 SD) had higher mean basal FSH (p < 0.05) and lower MFC (p < 0.01) levels than patients with normal ovarian volume. In conclusion, transvaginal ultrasound (TVU) indices and indirect hormonal parameters of ovarian reserve were similar in infertile and fertile women aged between 35 and 45 years. It is suggested that, in infertile women above 35 years of age, TVU rather than hormonal parameters be preferred, based on our data showing a stronger association between age and TVU indices of ovarian reserve than between age and increase in basal FSH level. Thus, TVU assessment of ovarian volume and antral follicle counts is a practical and cost-effective, if not better, technique for ovarian reserve testing.     

Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve

OBJECTIVE: To identify and quantify predictors of poor ovarian response in in vitro fertilization (IVF). DESIGN; Prospective study. SETTING; Tertiary fertility center. PATIENT(S): One hundred twenty women undergoing their first IVF cycle. INTERVENTION(S): Measurement of the number of antral follicles and the total ovarian volume by ultrasound, and of basal levels of FSH, E(2), and inhibin B on cycle day 3. MAIN OUTCOME MEASURE(S): Ovarian response, and clinical and ongoing pregnancy rates. RESULT(S); The antral follicle count was the best single predictor for poor ovarian response: area under the receiver operating characteristic curve = 0.87. Addition of basal FSH and inhibin B levels to a logistic model with the antral follicle count significantly improved the prediction of poor response; the addition of basal E(2) levels and total ovarian volume did not improve the prediction. To express the discriminative performance of this model toward poor response, a maximum area under the receiver operating characteristic curve of 0.92 was calculated. Poor responders had significantly lower clinical and ongoing pregnancy rates than did normal responders. CONCLUSION(S): Our data demonstrate that the antral follicle count provides better prognostic information on the occurrence of poor response during hormone stimulation for IVF than does the patient's chronological age and the currently used endocrine markers. However, endocrine tests remain informative. Multivariate models can achieve more accurate predictions of outcomes of complex events like ovarian response in IVF.     

四种预测卵巢储备指标的临床研究

目的 :在体外受精 胚胎移植 (IVF ET)患者中对预测卵巢储备的 4种指标进行临床研究 ,以期寻找 1～ 2种灵敏度高的指标用于普通不孕人群。方法 :随机选择不同年龄段的 90例不孕患者 ,在接受IVF ET前 1～ 2个周期 ,于月经第 3天取空腹血测定基础性激素水平 ;于月经第 5～ 9天服氯米酚 (CC) 10 0mg,第 10天取空腹血测定FSH、LH、E2 ;开始进入IVF ET周期前 ,B超测量卵巢体积 ,观察IVF ET过程中卵巢的反应性。结果 :随年龄增加 ,卵巢反应不良及取消周期的比例增加 ;随基础FSH、服CC后FSH水平升高 ,卵巢反应性降低。卵巢体积较小组 ,卵巢反应不良的比例占 5 2 0 %。结论 :年龄是一个较为敏感的指标 ;基础FSH水平对卵巢储备的评估优于CC兴奋试验和卵巢体积测定。由于B超检查简便无侵入性 ,因此 ,认为基础FSH水平配合年龄和卵巢体积综合评估 ,将有助于提高预测价值。     

Inhibin B response to EFORT is associated with the outcome of oocyte retrieval in the subsequent in vitro fertilization cycle

Objective: To examine whether the magnitude of the rise in inhibin B levels after gonadotropin challenge is associated with subsequent response to ovarian stimulation during IVF.

Design: Inhibin B serum levels after EFORT (exogenous follicle-stimulating hormone ovarian reserve test).

Setting: Academic clinical practice.

Patient(s): Serum samples from women who had undergone ovarian reserve screening with FSH in preparation for IVF. Thirteen of these women had a poor response in IVF (canceled cycle for low estradiol and/or no oocytes retrieved), and 19 had a good response (≥10 oocytes retrieved).

Intervention(s): EFORT test.

Main Outcome Measure(s): Baseline (day 3) serum E₂ (bE₂), FSH (bFSH), and inhibin B (bInhB) levels and inhibin B and E₂ levels 24 hours after EFORT (ΔInhB and ΔE₂).

Result(s): The mean bInhB and ΔInhB levels were significantly higher in good vs. poor responders. The odds ratio of having a good response for women with a ΔInhB of 202 pg/mL was 51.8 times (95% CI = 6.1–1,244) the corresponding odds for women with a ΔInhB of 49 pg/mL. As expected, ΔE₂ was also significantly higher in good vs. poor responders; however, combination of ΔE₂ plus ΔInhB did not improve the odds for predicting IVF response.

Conclusion(s): Our data suggest that ΔInhB after EFORT may provide a method for predicting ovarian response to hyperstimulation in a subsequent IVF cycle.     

Ovarian Reserve Test with Human Menopausal Gonadotropin as a Predictor of In Vitro Fertilization Outcome

Purpose: Our purpose was to determine prospectively, usingreceiver-operating characteristic (ROC) analysis, whetherthe ovarian reserve test with hMG could improve thepredictive value of a woman's age and basal levels of folliclestimulating hormone (FSH), E₂, and inhibin or anycombination of them regarding ovarian response and pregnancy ratein IVF treatment following pituitary desensitization. Methods: The hMG test was performed within 3 months ofIVF treatment in 80 women undergoing the first cycle ofIVF and consisted of 2 ampoules of hMG daily for 5 daysstarting on cycle days 2 to 3. Hormone and ultrasoundevaluation was performed on cycle days 2 to 3 and 7 to 8. Results: The mean age and basal FSH levels weresignificantly higher in the canceled (n = 28) than in the control(n = 52) group, whereas the basal inhibin level wassignificantly higher in the latter. Regarding ovarian response, thecombination FSH plus inhibin had the better diagnosticaccuracy (predictive value of 70%) among basal variables.When post-hMG parameters (alone or in combination) wereanalyzed, E₂ alone, with a 77% diagnostic accuracy,emerged as the best predictive variable of cancellation inIVF cycles. When ROC analysis was used, the area underthe ROC curve for E₂ post-hMG (diagnostic accuracy of84.5%) was significantly higher than that for the estimatesbased on the combination of basal FSH and inhibin(diagnostic accuracy of 71.3%). However, woman's age was theonly variable independently associated with pregnancy rate. Conclusions: The predictive power of the hMG test ofovarian reserve is better than that of age and basal hormonevalues (FSH and inhibin) and it is based mainly on the E₂response to hMG treatment. However, given that age is theonly predictor of pregnancy and considering the cost anddiscomfort of the hMG test, the usefulness, if any, of the testin predicting IVF performance in the daily clinical settingremains to be established.     

Women with regular menstrual cycles and a poor response to ovarian hyperstimulation for in vitro fertilization exhibit follicular phase characteristics suggestive of ovarian aging

OBJECTIVE: To investigate whether follicular phase characteristics associated with ovarian aging can be observed in women of normal reproductive age, who had previously shown a poor response to ovarian hyperstimulation for IVF. DESIGN: Observational, prospective study. SETTING: Tertiary fertility center. PATIENT(S): Eleven regularly cycling, ovulatory women, aged 29-40 years who previously presented with fewer than four dominant follicles after ovarian hyperstimulation for IVF. INTERVENTION(S): Frequent serum hormone assessments and transvaginal ultrasound during the follicular phase of a spontaneous, unstimulated cycle. MAIN OUTCOME MEASURE(S): Duration of the follicular phase; serum LH, FSH, E(2), P, inhibin A, and inhibin B levels; and number of antral follicles observed by ultrasound. Results were compared with the cycle characteristics of a reference population of 38 healthy normo-ovulatory women aged 20-36 years (as published elsewhere). RESULT(S): Poor responders had significantly fewer antral follicles than controls. Median FSH concentrations were significantly higher compared with controls, but the majority had FSH levels within the normal range. Follicular phase P levels were significantly higher in poor responders. Duration of the follicular phase, E(2), and inhibin A and inhibin B serum levels did not differ between poor responders and controls. CONCLUSION(S): Normo-ovulatory regularly cycling women with a previous poor response to ovarian hyperstimulation for IVF show follicular phase characteristics suggestive of ovarian aging.     

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。     

Early follicular anti-mullerian hormone as a predictor of ovarian response during ICSI cycles

ObjectiveTo evaluate the use of AMH in predicting the ovarian response in ICSI cycles compared to other markers of ovarian function.DesignProspective study.SettingIVF/ICSI Unit; Enjab Hospital for infertility, Gulf Medical College and Research Centre (UAE) and Biochemistry department, Faculty of Pharmacy for Girls, Al-Azhar University (Egypt).Subject(s)A total of 220 infertile women attending an ART program (ICSI) for the first time during the period from June 2007 to October 2009 who met the inclusion criteria were our subjects . On day-3 of the menstrual cycle, serum levels of AMH, FSH, LH, E2, and inhibin B were measured for each woman. Early antral follicles were evaluated by vaginal ultrasound. Thereafter, the patients were classified according to oocyte count into two groups; Good responders (those with ?4 oocytes) and poor responders (those with <4 oocytes).Intervention(s)None.Main outcome measure(s)Comparison of day-3 serum AMH levels in both groups. Antral follicle count, basal FSH, LH, E2 and inhibin B were also compared.ResultsThe serum level of AMH, AFC and FSH levels were significantly different in both groups. Parameters such as serum LH, E2 and inhibin B levels were not significantly different between the two groups. Ovarian response was significantly correlated with basal AMH levels, FSH levels and AFC. However, AMH levels were highly correlated with the number of retrieved oocytes (P<0.001) than did AFC (P<0.01) or FSH (P<0.05) on day-3 of the cycle. Day-3 AMH was more sensitive and specific with higher predictivity for ovarian response than either day-3 AFC or day-3 FSH.ConclusionSerum AMH levels may reflect ovarian response better than the usual hormone markers.     

Age-related changes in ovarian volume,antral follicle counts and basal FSH in women with normal reproductive health

OBJECTIVE: To investigate the relation between ultrasound-based ovarian volume and antral follicle counts and hormonal parameters of ovarian reserve in a group of women with normal reproductive health. STUDY DESIGN: Prospective study. One hundred eight women with at least one previous pregnancy reaching term were divided into three age groups (group 1 = 35-39 years, group 2 = 40-44 years, and group 3 = 45-50 years). Basal hormone measurements and transvaginal ultrasonography estimation of ovarian volume and follicle counts were performed in the early follicular phase (day 3) of the menstrual cycle. RESULTS: There were significant differences in FSH (P < .0001) and E2 (P < .002) levels when group I was compared to groups II and III. There was a significant decrease in mean follicle counts (MFC) between groups I and III (P < .05). The decrease in mean ovarian volume (MOV) with age was not statistically significant. Age strongly correlated with MFC (r = -.38, P < .001) and weakly with MOV (r = -.29, P < .05). However, basal FSH correlated positively with age (r = .50, P < .001) and negatively with MOV (r = -.590, P < .001) and MFC (r = -.658, P < .001). Basal E2 correlated with MOV (r = .50, P < .001) and MFC (r = .50, P < .001). There was also a strong positive correlation between MFC and MOV (r = .777, P < .001). CONCLUSION: There was a decrease in MOV and MFC with aging coincident with increasing basal FSH levels after age 35 in women with normal reproductive health.     

Differentiating clinical profiles: predicting good responders, poor responders, and hyperresponders

Objective: To describe the different clinical and laboratory diagnostic methods (basal and dynamic tests) available to identify poor-, good-, and high-responder patients undergoing treatment with in vitro fertilization (IVF).

Design: Analytical review.

Setting: IVF program.

Patients: Women in different age groups undergoing IVF treatment.

Intervention(s): Assessment of clinical and laboratory parameters and correlation with outcomes.

Main Outcome Measure(s): Response to ovarian stimulation and success of the assisted reproductive technologies (ART).

Result(s): Age, basal follicle-stimulating hormone (FSH), estradiol and inhibin-B levels, and dynamic testing serve to predict individual response to ovarian stimulation for ART.

Conclusion(s): Markers of ovarian reserve (day 3 FSH, inhibin B and E₂) are particularly predictive and useful in guiding the choice of the optimal protocol for ART. However, no tests are absolutely predictive of a successful outcome. For the younger individual, and for the patient at risk of developing ovarian hyperstimulation syndrome (OHSS), assessment and identification of clinical and laboratory parameters predictive of a high response to ovarian stimulation should guide the clinician in choosing an appropriate stimulation protocol, thus attenuating the risk of OHSS.     

Single and Repeated GnRH Agonist Stimulation Tests Compared With Basal Markers of Ovarian Reserve in the Prediction of Outcome in IVF

Purpose: To study the value of a single or repeated GnRH agonist stimulation test (GAST) in predicting outcome in IVF compared to basal ovarian reserve tests.Methods: A total of 57 women was included. In a cycle prior to the IVF treatment, on day 3, an antral follicle count (AFC) was performed and blood taken for basal FSH, inhibin B and E₂ measurements, followed by a subcutaneous injection of 100 g triptorelin for the purpose of the GAST. Twenty-four hours later blood sampling was repeated. All the tests were repeated in a subsequent cycle. From the GAST E₂ and inhibin B response were used as test parameters. The outcome measures were poor ovarian response and ongoing pregnancy. Group comparisons were done using the Mann– Whitney or chi-square test. Univariate and multivariate logistic regression was applied to assess which test revealed the highest predictive accuracy as expressed in the area under receiver-operating characteristic curve (ROC_AUC). Clinical value was compared by calculating classical test characteristics for the best logistic models.Results: All the basal and GAST variables were significantly different in the poor responders (n = 19) compared to normal responders (n = 38). In the univariate analysis on cycle 1 tests the AFC was the best predictor for poor ovarian response, while in cycle 2 the E₂ response in the GAST performed best (ROC_AUC of 0.91 for both). Multivariate analysis of the basal variables led to the selection of AFC and inhibin B in cycle 1, yielding a ROC_AUC of 0.96. Mean E₂ response was selected in a multivariate analysis of the repeated GAST variables (ROC_AUC 0.91). At a specificity level of 0.90, several logistic models including GAST variables appeared to have a sensitivity (0.80), positive predictive value (0.82) and false positive rate (0.18), comparable to a logistic model containing AFC and inhibin B. None of the test variables showed a significant relation with ongoing pregnancy.Conclusions: The GAST has a rather good ability to predict poor response in IVF. However, comparing the predictive accuracy and clinical value of the GAST with a day 3 AFC and inhibin B, it appeared that neither a single nor a repeated GAST performed better. In addition, the predictive ability towards ongoing pregnancy is poor. Therefore, the use of the GAST as a predictor of outcome in IVF should not be advocated.     

Ovarian reserve in women with polycystic ovary syndrome who underwent laparoscopic ovarian drilling

Objective. To evaluate ovarian reserve assessed by hormones and sonography in women with polycystic ovary syndrome (PCOS) undergoing laparoscopic ovarian drilling (LOD).

Methods. This was a cross-sectional study. Twenty-one PCOS women undergoing LOD were enrolled in the study (the LOD group). Their day-3 anti-Müllerian hormone (AMH), inhibin B, follicle-stimulating hormone (FSH) levels, antral follicles count (AFC) and summed ovarian volume representing ovarian reserve were compared with those of PCOS women who did not undergo LOD (the PCOS group) and those of normal ovulatory women (the control group).

Results. There were no differences in age and body mass index between groups. AMH levels seemed to be lower in the LOD (4.60 ± 3.16 ng/ml) than in the PCOS (5.99 ± 3.36 ng/ml) groups, but did not reach statistical significance. Day-3 FSH levels were significantly higher and AFC was significantly lower in the LOD than in the PCOS group. AMH levels, AFC and summed ovarian volume were significantly greater, but FSH was significantly lower, in the PCOS group compared with the control group. There were no differences in inhibin B levels between groups.

Conclusion. This study showed that ovarian reserve assessed by hormonal levels and sonography seems to be lower in the LOD than in the PCOS group. The PCOS women both with and without LOD had significantly greater ovarian reserve than the age-matched controls having normal ovulatory menstruation.     

克罗米芬对卵巢储备功能减退患者进行促排卵治疗的有效性研究

目的:研究IVF/ISCI治疗中克罗米芬(CC)用于卵巢储备功能减退(DOR)患者促排卵治疗的效果。方法:回顾性分析年龄<35岁但基础FSH≥12 IU/L,或者年龄≥35岁患者的388个CC联合人绝经期促性腺素(hMG)的促排卵周期全胚行冻融胚胎移植(FET)的治疗结局,所有患者既往有≥1次促排卵治疗失败史。结果:年龄<35岁组,获卵数为4.5±3.1个,有效胚胎数为2.2±1.8个,优质胚胎数为1.6±1.5个,用药时间为8.8±2.0 d。在年龄≥35岁的患者中,获卵数为4.5±2.8个,有效胚胎数为2.2±1.8个,优质胚胎数为1.9±1.6个,用药时间为8.8±1.9 d。FET的临床妊娠率2个年龄组分别为37.8%和36.4%,组间无统计学差异(P>0.05)。结论:对于基础FSH水平高或者年龄≥35岁的DOR患者,CC联合hMG是一种有效的促排卵方案。     

Prediction of response to controlled ovarian hyperstimulation: a comparison of basal and clomiphene citrate-stimulated follicle-stimulating hormone levels.

OBJECTIVE: To test the ovarian reserve in a high-risk population before controlled ovarian hyperstimulation for in vitro fertilization (IVF). DESIGN: A prospective study comparing the outcome of a clomiphene citrate (CC) challenge test to the outcome of subsequent IVF cycles. SETTING: Unit for assisted reproductive technology in a university hospital. PATIENTS, PARTICIPANTS: Ninety-one infertile women with an age of 35 years or more, who had previous ovarian surgery or who had been diagnosed with ovarian endometriosis. MAIN OUTCOME MEASURE: Relate follicle-stimulating hormone (FSH) levels before and after CC to frequency of cancellation of an IVF cycle because of a poor follicular response. RESULTS: Twenty-one patients had elevated basal levels of FSH. Thirty-seven patients, including 20 with high basal levels, showed an excessive FSH response to CC with an FSH level after CC above the 95% confidence limit. Clomiphene citrate-stimulated FSH levels correlated better than basal levels with response to controlled ovarian hyperstimulation. An excessive FSH response to CC predicted a poor response outcome of subsequent controlled ovarian hyperstimulation for IVF with 85% accuracy. CONCLUSION: Follicle-stimulating hormone response to CC predicts subsequent follicular response to controlled ovarian hyperstimulation.     

Ovarian function and vascular resistance after tubal sterilization

OBJECTIVE: To investigate the effect of tubal sterilization (laparoscopic bipolar coagulation) on serum baseline follicle-stimulating hormone (FSH) and estradiol levels, ovarian volume, antral follicle counts and ovarian artery blood flow rate and to evaluate the correlation of these parameters. STUDY DESIGN: Nineteen women who underwent tubal sterilization with laparoscopic bipolar coagulation were enrolled in the study. Ovarian volume, antral follicle counts, serum hormone levels and ovarian artery resistivity index values were measured before and 1 year after the sterilization procedure on the third day of the menstrual cycle. RESULTS: Serum hormone levels, mean ovarian volume (MOV) and mean follicle counts (MFC), were not statistically significant before and 1 year after the operation (P > .05). The difference in ovarian artery resistivity index values was not statistically significant before and 1 year after the operation (P > .05). A significant correlation was observed between FSH, MOV and MFC before and after the operation (P < .05). No correlation was observed between MOV or MFC and resistivity index. CONCLUSION: Ovarian function and vascular resistance do not seem to be affected by laparoscopic bipolar tubal coagulation.     

Antral follicle count, anti-mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology?

OBJECTIVE: The objective of this study was to evaluate the relationship between anti-mullerian hormone (AMH), inhibin B and antral follicle count (AFC) with ovarian response. DESIGN: Retrospective study. SETTING: Fertility unit. SAMPLE: AFC was recorded, and a serum sample obtained on day 3 from all patients undergoing in vitro fertilisation (IVF). Patients were given 300 IU/L recombinant follicle stimulating hormone (FSH; Gonal F). The following day blood samples were collected. METHODS Serum samples were assayed for FSH, AMH and inhibin B using commercial immunoassay kits and oestradiol using an in house assay. MAIN OUTCOME MEASURES: Response to gonadotrophin stimulation and the number of eggs collected. RESULTS: AFC was negatively correlated to age (r=-0.426, P < 0.001). Delta inhibin B (levels of inhibin B on day 4 minus day 3) had the best association to the number of eggs collected (r= 0.533, P < 0.001) followed by basal AMH (r= 0.51, P < 0.001) and AFC (r= 0.505, P < 0.001). The number of eggs fertilised was significantly associated with basal AMH (r= 0.592, P < 0.001) and inhibin B (r= 0.548, P < 0.001). AMH with a cutoff of 0.2 ng/mL had the best sensitivity (87%) and specificity (64%) in predicting poor response. A cumulative score using basal FSH, basal AMH, delta E2 (levels of oestradiol on day 4 minus day 3), delta inhibin B, AFC and age gives the best predictive statistics to identify poor responders with 87% sensitivity and 80% specificity and a positive likelihood ratio of 4.36. CONCLUSION: Delta inhibin B had the best positive association with the number of eggs collected and basal AMH is the single best predictor of poor response. AFC has a significant association with the number of eggs collected and is predictive of clinical pregnancy. It is evident that a single parameter is of limited value in predicting ovarian response. However, we have demonstrated a cumulative score using all the above markers could be useful in predicting poor response.     

The Practical Implications of a Raised Serum FSH and Age on the Risk of IVF Treatment Cancellation Due to a Poor Ovarian Response

PURPOSE: Chronological age, or biological age as indicated by elevated FSH levels, are related to ovarian reserve. This study addresses the likelihood of cancellation of IVF treatment due to a poor ovarian response utilising both basal serum FSH and woman's age. METHODS: A prospective cohort of 536 infertile but ovulating women were studied in their first cycle of IVF treatment. Standardised methods of pituitary desensitisation and ovarian stimulation prior to IVF treatment were employed. Treatment cycles cancelled due to a poor ovarian response to gonadotrophins were studied. A series of logistic regression models were used to explore the probabilities of cancellation in relation to age and FSH. RESULTS: Both age and basal serum FSH levels were independently associated with the risk of treatment cancellation. A low risk of treatment cancellation was observed in women under the age of 35 irrespective of serum FSH, however in older women the risk of treatment cancellation was most likely in women with a high FSH. CONCLUSIONS: In combination both age and FSH may serve as a valuable indicator of poor ovarian response leading to treatment cancellation. However, among older women FSH has particular importance, while less so in younger women with regular menstrual cycles.     

预测体外受精中卵巢反应性相关因素分析

目的:比较基础抑制素B(basal inhibin B,bINHB)、基础卵泡刺激素(bFSH)、年龄、窦卵泡计数(AFC)对于体外受精中卵巢反应的预测价值。方法:选取首次施行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)患者796例,于促排卵开始前1个月,测定月经第3日血清bINHB、bFSH水平,B超测定当日卵巢内AFC,分别比较其与获卵数的相关性。结果:bINHB、AFC与获卵数呈正相关性,相关系数(r)分别为0.147和0.661;bFSH、年龄与获卵数呈负相关,r分别为-0.239和-0.355,均P<0.001。按|r|值行相关性排序,bINHB、bFSH、年龄、AFC与获卵数相关性递增。结论:bINHB、bFSH、年龄、AFC均可以预测卵巢反应性,AFC是预测卵巢反应最好的指标。     

卵巢储备功能测定在体外受精(IVF)技术中的临床价值探讨

目的:探讨在体外受精-胚胎移植技术中对超促排卵最具临床价值的卵巢储备功能测定指标。方法:将2003.10-2004.10间,105例接受IVF-ET治疗的不孕患者的年龄、基础FSH值、基础窦卵泡数、卵巢体积和卵巢基质血流测定指标与IVF超排中卵巢的实际反应进行对比并作相关性分析。结果:年龄、FSH与获卵数呈非常显著负相关,与促性腺激素(Gn)注射支数呈显著正相关;窦卵泡数、卵巢体积与获卵数呈非常显著正相关,与Gn注射支数呈非常显著负相关;其中以基础窦卵泡数与卵巢反应关系最为密切。卵巢基质血流与卵巢反应无显著相关。结论:年龄、基础FSH值、阴道超声测量基础窦卵泡数和卵巢体积均能预测超排时卵巢对促性腺激素刺激的反应性,并有简便、经济之优点,其中以窦卵泡计数的预测价值最高,窦卵泡计数不仅可用于卵巢低反应的预测,还可预测卵巢反应过激,而年龄与基础FSH仅在预测卵巢低反应中较为敏感,卵巢基质血流对预测卵巢反应的意义有待进一步探讨。     

Performance of basal follicle-stimulating hormone in the prediction of poor ovarian response and failure to become pregnant after in vitro fertilization: a meta-analysis

OBJECTIVE: To assess the predictive performance and clinical value of basal FSH as a test for ovarian reserve in in vitro fertilization (IVF) patients. DESIGN: Meta-analysis. SETTING: Tertiary fertility center. PATIENT(S): Patients undergoing IVF. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Poor ovarian response, nonpregnancy. RESULT(S): We located 21 studies that had reported on basal FSH and IVF outcome. No single study met high standards of methodological rigor; most studies are of moderate methodological quality only. The summary receiver operating characteristic curve indicated a moderate predictive performance for poor response, and a low predictive performance for nonpregnancy. Predictions with a substantial shift from pre-FSH-test probability to post-FSH test probability are only achieved at extreme cut-off levels for basal FSH. Sensitivity of such cut-off levels, for both the prediction of poor response and nonpregnancy, is limited. CONCLUSION(S): Clinical value of testing for basal FSH is restricted to a small minority of patients. Basal FSH should not be regarded as a useful routine test for the prediction of IVF outcome. The development of better tests to assess ovarian reserve remains of importance.