阴道彩超预测基础FSH水平正常患者超排卵中卵巢反应性的价值

目的 探讨经阴道彩色多普勒测量早卵泡期窦卵泡计数(antral fomcle count，AFC)及卵巢基质血流峰值流速(stromal peak systolic velocity，PSV)、阻力指数(resistance index，RI)在预测基础卵泡刺激素(basal fomcle stimulating hormone，bFSH)水平正常患者促性腺激素释放激素激动剂(GnRH-α)短方案超排卵(controlled ovarian hypersimulation COH)治疗中卵巢反应性的价值。方法 2003年9月-2004年8月在该院生殖医学中心接受体外受精(in-vitro fertilization，IVF)或单精子胞浆内注射(intracytoplasmic sperm injection，ICSI)助孕治疗的不孕症患者，bFSH水平为该中心行IVF的正常值范围。于月经第2天行阴道彩超检查，测量早卵泡期AFC及PSV、RI，并在当周期行GnRH-α短方案COH治疗，观察获卵数以判断卵巢的反应性。结果 45例bFSH水平正常患者接受COH治疗，在匹配了年龄和bFSH水平后观察到反应正常组与反应不良组AFC与PSV差异有显著性，外源性卵泡刺激素用量及刺激时间差异有显著性，而RI差异无显著性。促排卵反应不良病史也是卵巢低反应性的影响因素。结论 经阴道彩超测量早卵泡期AFC及PSV是bFSH水平正常患者进行GnRH-α短方案COH前评价卵巢反应性的较好指标。

Impact of TVCD on prediction of poor ovarian response in women with normal basal follicle-stimulating hormone levels undergoing in intro fertilization

[Objective]To study the values of antral follicle count (AFC) and intraovarian blold flow on the prediction of poor ovarian response in women with normal basal follicle-stimulating hormone levels undergoing short protocol in vitro fertilization. Serum FSH in 45 infertile were tested at the second day of menses, and transvaginal color Doppler (TVCD) estimated the basic ovarian status [AFC, mean ovarian stromal peak systolic velocity (PSV), resistance index (RI)]. The cut-off value for basal FSH in our study was less than 8.00 IU/L. In this study we defined poor response as: collection of fewer than 4 oocytes at retrieval or cycle cancellation to impaired follicular reaction (<3 follicles) in response to exogenous gonadotropins. According to the results of oocytes retrieval, the patients were divided into 2 groups: normal and poor ovarian response. [Results] To woman with normal basal follicle-stimulating hormone levels undergoing short protocol in vitro fertilization, AFC and PSV were clearly predictive of poor ovarian response. History of poor response to ovarian stimulation was a strong indicator for declining ovarian function. [Conclusion] AFC and PSV are good predictors of ovarian response in IVF. We suggest that women with normal basal follicle-stimulating hormone levels in IVF should be evaluated by TVCD to improve the value of prediction.