血清抑制素水平在体外受精-胚胎移植超排卵周期中预测卵巢反应性的价值

目的探讨血清抑制素水平在体外受精-胚胎移植(IVF-ET)超排卵周期中与卵巢反应性的相关性及其预测价值。方法对37例初次接受IVF-ET、基础卵泡刺激素(FSH)水平<12U/L的患者,于IVF前1周期月经第2~4天及黄体中期、IVF周期重组rFSH注射第5天、人绒毛膜促性腺激素(hCG)注射日、取卵日及黄体中期,分别检测血清雌二醇、孕酮、抑制素(INH)A及INHB水平。根据IVF周期中的获卵数、雌二醇峰值水平、是否发生卵巢过度刺激综合征(OHSS)的情况,将37例患者分为卵巢低反应者8例(A组)、卵巢正常反应者及卵巢高反应者29例(B组),比较两组IVF-ET临床效果及注射rFSH前后INH、雌二醇及孕酮水平的变化。通过多重逻辑回归分析、受试者工作特征曲线分析,评价各激素水平预测卵巢反应性的准确性;通过敏感度、特异度的计算确定INHB诊断的临界值。结果(1)A、B组IVF前1周期月经第2~4天INHB水平分别为(37±35)、(91±90)ng/L;IVF周期注射rFSH第5天的INHB水平分别为(194±157)、(2254±4765)ng/L,INHA水平分别为(36±35)、(91±90)ng/L,两组比较,差异有统计学意义(P<0·05)。(2)获卵数与IVF前1周期月经第2~4天INHB水平、IVF周期rFSH注射后各阶段的INHB、INHA及雌二醇水平呈显著正相关(INHB:r=0·39~0·67,P<0·05;INHA:r=0·43~0·59,P<0·01;雌二醇:r=0·50~0·60,P<0·01)。(3)受试者工作特征曲线分析显示,注射rFSH第5天的INHB水平的最大的曲线下面积为0·948(95%可信限为0·871~1·025),将INHB为400ng/L作为临界值时,其对卵巢反应性的预测敏感度为82·8%,特异度为99·1%。结论基础INHB水平、IVF周期rFSH注射第5天的INHB水平均是预测卵巢反应性较好的标记物;IVF周期rFSH注射第5天的INHB水平对卵巢反应性具有最佳的预测价值。

Value of serum inhibin B measurement in predicting ovarian response in controlled ovarian hyperstimulation for in vitro fertilization cycle

OBJECTIVE: To explore the value of serum inhibin measurement in predicting ovarian response in infertile patients undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) cycle. METHODS: A total of 37 patients undergoing their first cycles of IVF treatment were studied and serum estradiol (E(2)), progesterone (P), inhibin (INH) B, INHA levels were detected on days 2 - 4 and 21 of the previous cycle, on day 5 of gonadotropin therapy (day 5), hCG injection day, oocyte retrieval day and at middle luteal phase of the IVF cycle. According to number of oocytes, peak E(2) concentration and presence or absence of ovarian hyperstimulation syndrome (OHSS), the 37 patients were allocated into two groups: poor ovarian response group (group A), normal and high response group (group B). Characteristics of the treatment cycle and INH, E(2), P levels were analyzed. A multiple logistic regression model and receiver operating characteristic (ROC) analysis were then used for all possible prognostic variables to evaluate the value of different hormone in predicting ovarian response. The sensitivity and specificity were calculated at the discriminating cut-off point. RESULTS: (1) In group A, basal serum INHB level, INHB and INHA levels on day 5 of recombinant FSH (rFSH) stimulation were significantly lower than group B (P < 0.05), and basal serum INHB levels were (37 +/- 35), (91 +/- 90) ng/L respectively, INHB levels on day 5 of rFSH stimulation were (194 +/- 157), (2254 +/- 4765) ng/L respectively, INHA levels on day 5 of rFSH stimulation were (36 +/- 35), (91 +/- 90) ng/L respectively in groups A and B. (2) There was positive correlation between oocytes number and basal inhibin B and dynamic serum inhibin B levels, inhibin A and E(2) levels of rFSH therapy (INHB: r = 0.39 - 0.67, P < 0.05; INHA: r = 0.43 - 0.59, P < 0.01; E(2): r = 0.50 - 0.60, P < 0.01). (3) ROC analysis: day 5 inhibin B had the largest area under curve (AUC) 0.948 (95% CI: 0.871 - 1.025), indicating that a threshold of 400 ng/L gave 82.8% sensitivity, and 99.1% specificity. CONCLUSIONS: The basal INHB levels and INHB measured on day 5 of rFSH stimulation may offer accurate and early prediction of ovarian response. Day 5 INHB levels are the best predictor of ovarian response.