评估卵巢储备功能的常用指标对预测卵巢反应性的价值比较

目的比较评估卵巢储备功能的常用指标在各年龄段对预测卵巢反应性的价值。方法回顾性分析1 478例行IVF/ICSI-ET助孕、符合入选标准的不孕女性的临床资料。根据年龄分为A组(≤30岁)、B组(30～38岁)、C组(>38岁);组内根据获卵数分为卵巢低反应组(<6个)、卵巢正常反应组(6～18个)及卵巢高反应组(>18个)。比较基础FSH(bFSH)、抗苗勒管激素(AMH)、基础雌二醇水平(bE₂)及窦卵泡数(AFC)单独及联合应用在各年龄段对卵巢反应性的预测价值。结果 bFSH、AMH、AFC在各年龄组间及卵巢反应亚组间均有显著差异(P<0.01);bE₂在各年龄组间及卵巢反应亚组间均无显著差异(P>0.05)。ROC曲线分析显示,单一指标预测卵巢反应性时,AMH的曲线下面积最大;联合指标对于预测30～38岁组卵巢低反应(联合bFSH、AMH、AFC)、>38岁组卵巢低反应(联合bFSH、AMH及年龄)和卵巢高反应(联合bFSH、AMH),可提高其ROC曲线下面积、预测敏感度和特异度。结论血清AMH作为单...

Comparison value of common indicators for assessing ovarian reserve function in predicting ovarian response

Objective:To compare the value of common indicators used to assess ovarian reserve for predicting ovarian response in the patients of different ages.Methods:The data of 1478 infertile women who underwent IVF/ICSI-ET and eligible for the inclusion criteria were retrospectively analyzed.They were divided into three groups according to the age:group A(age≤30 years),group B(3038 years).Then the patients of each group were subdivided into poor(n<6),normal(6≤n≤18),and high(n>18)ovarian response group according to the number of oocytes retrieved.The value of basal FSH,anti-Mullerian hormone(AMH),basal E2 and antral follicle number(AFC)in predicting ovarian response were compared in 3 age groups.Results:There were significant differences in serum basic FSH,AMH and AFC among the three age groups and among the subgroups of different ovarian response(P<0.01),but the serum basic E2 had no significant difference(P>0.05).ROC curve analysis showed that the area under the curve of AMH as single indicator predicting ovarian response is the largest.The combination of multiple indicators can increase the area under the ROC curve,predictive sensitivity and specificity for poor response in the group of 30-38 years old(combined use of the indicators of bFSH,AMH&AFC),poor(combined use of the indicators of bFSH,AMH&age)and high response(combined use of the indicators of bFSH&AMH)in the group of>38 years old.Conclusions:Serum AMH as single indicator for predicting ovarian response is the most valuable.For women of aged 30-38 years,a combination of multiple indicators can significantly improve the value of predicting poor ovarian response.For women>38 years old,a combination of multiple indicators can significantly improve the predicting value both in poor and high ovarian response.