女性基础睾酮水平对体外受精-胚胎移植妊娠结局的影响

目的 通过对基础性激素正常的不孕女性, 研究其血清基础睾酮 (basal testosterone, bT) 水平对体外受精-胚胎移植 (in vitro fertilization embryo transfer, IVF-ET) 妊娠结局的影响, 评估bT水平对妊娠结局的预测价值及其临床运用的意义.方法 选择基础性激素水平正常的不孕女性229例.根据是否妊娠分为妊娠组 (A组, 114例) 与非妊娠组 (B组, 115例) , 比较A、B两组患者的bT水平, 探讨bT水平能否对IVF-ET妊娠结局产生影响.再根据229例患者的b T水平情况差异进行受试者工作特征 (receiver operating characteristic, ROC) 曲线分析, 寻找其bT阈值.按照bT水平分为C组 (bT≤bT阈值组, 129例) 、D组 (b T>bT阈值组, 100例) , 进一步探讨bT水平与IVF-ET妊娠结局的关系.结果 (1) A组的bT水平、MⅡ卵率及优质胚胎率明显高于B组 (0.94±0.34) , (0.63±0.32) ], (1 208/1 419) 85.13%, (906/1 168) 77.57%], (432/828) 52.17%, (319/701) 45.51%) ], 差异有统计学意义 (P<0.05) ; (2) bT对妊娠结局有中度预测价值 (灵敏性:51.8%、特异性:35.7%) , 最佳b T阈值为0.72 nmol/L; (3) D组的MⅡ卵率及临床妊娠率高于C组 (1 078/1 173) 91.9%, (1 036/1 414) 73.27%], (59/100) 59%, (55/129) 42.64%], 差异有统计学意义 (P<0.05) .结论 基础性激素水平正常的不孕女性b T水平可对IVF-ET结局进行初步评估及预测, 对于bT低于阈值的患者, 可以通过外源性补充雄激素的方式, 将bT提高至阈值水平, 最终改善不孕女性IVF-ET妊娠结局.

Effect of Female Basal Testosterone Level on the Pregnancy Outcome of in Vitro Fertilization Embryo Transfer

Objectives To analyze the influence of female basal testosterone (bT) level of infertile women with normal serum sex hormones on the pregnancy outcome of in vitro fertilization embryo transfer (IVF-ET) and to evaluate the predictive value of bT on pregnancy outcome and its clinical significance. Methods A total of 229 cases of infertile women with normal serum sex hormones were selected and divided into pregnancy group (group A, n=114) and non-pregnancy group (group B, n=115) . The bT levels of the two groups were compared.The influence of bT value on IVF-ET pregnancy outcome was explored. Receiver operating characteristic (ROC) was analyzed according to the differences of bT levels of all the patients to find the bT threshold. Based on the bT levels, the patients were divided into group C (bT≤bT threshold, n=129) and group D (bT>bT threshold, n=100) . The relationship between bT value and IVF-ET pregnancy outcome was further explored. Results (1) The bT levels, MⅡ egg rate and high quality embryo rate in group A were significantly higher than those in group with B (0.94 ±0.34) , (0.63 ±0.32) ], (1208/1419) 85.13%, (906/1168) 77.57% ], (432/828) 52.17%, (319/701) 45.51%) ] (P<0.05) . (2) There was a moderate predictive value of bT on pregnancy outcome (sensitivity: 51.8%, specificity: 35.7%) . The best bT threshold was 0.72 nmol/L. (3) MⅡ egg rate and pregnancy rate in group D were significantly higher than those in group C (1078/1173) 91.9%, (1036/1414) 73.27%], (59/100) 59 % (55/129) 42.64%] (P<0.05) . Conclusions The bT levels of infertile women with normal sex hormone levels may preliminary predict and assess the outcome of IVF-ET. For the patients with bT level under the threshold, exogenous androgen supplements may be considered to increase to raise the bT level to a fine level therefore improve IVF pregnancy outcome.