卵泡刺激素刺激后血清抑制素B和雌二醇预测体外受精周期中卵巢的反应性及其相关性

目的 探讨以经重组卵泡刺激素（rFSH）刺激后体外受精（IVF）周期中不同时间血清抑制素B（INHB）、雌二醇（E2）的动态变化,预测不孕患者卵巢的反应性,为选择最佳的超促排卵方案提供理论依据。方法 采用酶联免疫吸附试验,测定57例不孕患者（年龄〈40岁）于IVF周期中的不同时问,即月经第3天、注射rFSH前、注射rFSH后1d,及注射rFSH后5d的血清INHB、E2水平,并与反映卵巢反应性的2个指标——获卵数／rFSH总量、（卵泡数／rFSH总量）的平方根进行相关性分析。根据本研究中卵泡数及获卵数、是否发生卵巢过度刺激综合征（OHSS）的情况,将57例患者分为低反应组、过度刺激组及正常反应组,比较3组注射rFSH后INHB及E2水平的变化。结果 （1）注射rFSH后1、5d,其血清INHB及E：水平均与卵巢反应性呈显著正相关（INHB：rS=0．69—0．73,E2：rS=0．60～0．73;P=0．000）。（2）低反应组、正常反应组及过度刺激组注射rFSH后5d,患者血清INHB水平分别为164．7、696．2及1263．5ng／L,E2水平分别为303．2、1709．5及4261．0pmol／L,低反应组明显低于正常反应组,正常反应组明显低于过度刺激组,3组分别比较,差异均有统计学意义（P（0．01）。结论 经rFSH刺激后,血清INHB及E2水平能较敏感地预测卵巢对rFSH刺激的反应性,且INHB比E2更敏感。INHB及E2水平降低,可预测卵巢的低反应性;反之,可预测发生OHSS。

Dynamic assay of serum inhibin B and estradiol concentrations obtained after gonadotrophin therapy as predictors of ovarian response in vitro fertilization cycle

Objective To study prospectively the values of basal and dynamic measurement of inhibin B(INHB), estrodiol (E_2)following gonadotrophin therapy in vitro fertilization(IVF)cycles in predicting ovarian response to stimulation in young women. Methods A total of 57 patients younger than 40 years of age undergoing their first cycle of long protocol IVF treatment were studied and serum INHB, E_2 levels were detected on day 3 of the menstrual cycle, before the first administration of gonadotrophin (day 0), on days 1 and 5 after gonadotrophin therapy(day 1, day 5 ). Ovarian response was presented by: number of oocytes/total rFSH dose and square root of (number of follicles/total rFSH dose). According to number of follicles, number of oocytes and presence or absence of ovarian hyperstimulation syndrome(OHSS), we categorized the results into three different groups: poor response, normal response and OHSS. Results (1) Hormone levels on days 1,5 of rFSH stimulation: There were positive correlation between INHB (r_S:0.69-0.73), E_2 (r_S:0.60-0.73) and ovarian response (P=0.000). (2) INHB, and E_2 levels on day 5 of rFSH stimulation were significantly different between poor response, normal response and OHSS groups(P<0.01), and INHB levels were 164.7,696.2 and 1263.5 ng/L respectively, and estrodiol levels were 303.2,1709.5 and 4261.0 pmol/L respectively. Conclusions Serum INHB, and E_2 levels shortly obtained after gonadotrophin therapy may offer an accurate and early prediction of ovarian response, and INHB response to ovarian stimulation may be a more sensitive and earlier index of ovarian response than estrodiol. Low serum INHB and E_2 levels may predict poor ovarian response; on the other hand, high serum INHB and E_2 levels may predict OHSS.