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。

Role of Total Antral Follicle Count in Evaluation of Ovarian Function and Prediction of Outcome after ART

Objective: To evaluate the predictive value of the antral follicle count in patients undergoing assisted reproductive technologies(ARTs).Methods: A retrospective study including 1 353 couples who undergoing IVF/ICSI was performed.The ovarian total antral follicle count(tAFC) was analyzed.All treatment cycles were divided into 4 groups according to the number of antral follicles(group A < 5,group B 5-10,group C 11-15 and group D > 15) to evaluate the influence of various factors.Results: tAFC had better value in predicting ovarian response and ovarian reserve than age and basal FSH,it predicted poor ovarian response if tAFC was less than 8 and high response if tAFC was more than 12.Also tAFC had better value in predicting outcome after ART than age and basal FSH,it predicted more possibility of clinical pregnancy if tAFC was more than 10 and more possibility of cycle cancellation if tAFC was more than 15 or less than 5.The group of patients who had more antral follicle count had a significantly higher rate of pregnancy(group C 42.3%,the highest).While the group of patients who had a fewer antral follicle count also had a significantly higher rate of cycle cancellation,but group D had a cancellation rate of 24.3% due to OHSS.Conclusion: tAFC was closely related with factors which affect ART outcomes,it could act as an indicator for predicting ART outcomes and also directly and effectively evaluate the ovarian reverve and ovarian response.The AFC might be considered as the test of first choice when estimating quantitative ovarian reserve before ART,it should be performed prior each ART cycle.