卵泡输出率、窦卵泡计数结合年龄评估卵巢反应性及预测体外受精临床结局的研究

目的:探讨卵泡输出率(Follicular Output Rate,FORT)、窦卵泡计数(antral follicle count,AFC)结合年龄评估卵巢反应性及预测体外受精临床结局的价值。方法:选择2014年6月至2016年6月连云港市妇幼保健院生殖中心行体外受精-胚胎移植的不孕症妇女,选择长方案促排卵治疗,共纳入197个治疗周期,新鲜周期获得治疗结局159个周期,分三个年龄组、三个AFC组,三个FORT组,分别比较临床资料、促排卵资料、实验室和临床结局等指标,评价年龄、AFC、FORT三个指标与卵巢反应及治疗结局的相关性以及三个指标之间的相关性分析。结果:妊娠组与非妊娠组比较,妊娠组的FORT、受精率、优质胚胎率均较非妊娠组高,差异具有统计学意义。随着年龄增加,Gn用量增加,注射人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)日当天雌二醇(estradiol,E_2)、获卵数、受精率、优质胚胎率、临床妊娠率及种植率均降低,差异具有统计学意义,但FORT在三种年龄段内无差异。三个不同AFC组相比较,随着AFC的增加,获卵数增加,实验室及临床结局指标无统计学差异。高、中、低FORT组比较,HCG日E_2在高FORT组中最高,在低FORT组中最低。获卵数、优胚率、临床妊娠率、胚胎种植率在低、中、高三组间逐步升高,差异有统计学意义。FORT、AFC、年龄三者之间无相关性。结论:联合年龄、AFC、FORT三种指标可以有效预测卵子的数量、质量、卵巢的反应性以及治疗结局。

Follicular output rate (FORT), antral follicle count (AFC) combined with age for evaluating ovarian response and predicting the outcome of in vitro fertilization

Objectives:To investigate the value of follicular output rate (FORT) and antral follicle count (AFC) combined with age in assessing ovarian reactivity and prognosis of in vitro fertilization.Methods:A total of 197 treatment cycles of in vitro fertilization were enrolled and 159 cycles outcome was available.The patients were from Lianyungang Maternal and Child Health Hospital Reproductive.Clinical data,ovulation data,laboratory and clinical outcomes were compared among the three age groups,three AFC groups and three FORT groups to evaluate the effectiveness of age,AFC and FORT in predicting ovarian response and treatment outcome.Results:Compared with the non-pregnancy group,the FORT,the fertilization rate and the quality embryo rate of the pregnant group were higher.The difference was statistically significant.With the increase of age,the dosage of Gn increased,and E2 with injection of HCG in the same day,the number of oocytes acquired,the fertilization rate,the high quality embryos rate and the clinical pregnancy rate decreased.The difference was statistically significant.However,there was no difference in FORT among the three age groups.As the number of AFC increased,laboratory and clinical outcomes didn't differ statistically between the three AFC groups.E2 with injection of HCG in the same day was the highest in the high FORT group and lowest in the low FORT group.The number of oocytes retrieved,the high quality embryo rate,the clinical pregnancy rate and the embryo implantation rate were gradually increased in the low,medium and high groups.The difference was statistically significant.There was no correlation among the FORT,AFC and age.Conclusion:Combining the indexes of age,AFC and FORT can effectively predict the number of eggs,quality,ovarian response and treatment outcome.