35岁以上不孕妇女卵巢反应及临床妊娠结局的预测

Predictors of Ovarian Response and Pregnancy Outcome in Women Aged ≥35 Years Undergoing Fertilization in Vitro

分析年龄、基础促卵泡素（FSH）水平和窦卵泡计数（AFC）对于年龄超过35岁不孕妇女的卵巢反应和临床妊娠结局的预测作用。2004年04月-2005年05月期间，选择年龄≥35岁的不孕妇女接受第一次体外受精（IVF）或单精子卵胞浆内注射（ICSI）治疗的共162例，根据对促排卵药物的反应分为正常反应组（109例）、低反应组（38例）、取消组（15例）。测定月经周期第2、3天血清基础FSH、雌二醇（E2），阴道B超检查黄体中期（D21）的AFC。取消组患者的年龄明显高于正常反应组和低反应组；取消组、低反应组的AFC均明显低于正常反应组；（p〈0．001，p〈0．05），取消组、低反应组的基础FSH均明显高于正常反应组（p〈0．001），3组的基础E2无统计学差别（p〉0．05）。正常反应组的成熟卵数、移植胚胎数、临床妊娠率、活产率均明显高于低反应组，差异有统计学意义。两组胚胎着床率没有差异（p=0．22）。回归分析研究发现AFC、基础FSH与获卵数有关，年龄、AFC与临床妊娠有关。35岁以上不孕妇女AFC和基础FSH对于卵巢的反应有良好的预测作用，而年龄和AFC对于IVF的临床妊娠有一定的预测作用。

The purpose is to evaluate age, basal FSH and antral follicle count （AFC） as predictors of ovarian response and pregnancy outcome in women ≥35 years of age undergoing in vitro fertilization. Between April 2004 and May 2005, a total of 162 women aged ≥35 years who started their first cycle of IVF or ICSI treatment in our centre were prospectively included in this study. According to their response to ovary stimulation, the patients were classified into 3 groups （normal response group, 109 patients, low response group, 38 patients; and cancellation group, 15 patients）. Serum basal FSH, and E2 level on day 2 or 3 were measured, AFC on mid-luteal phase of cycle （day 21 ） was determined by transvaginal ultrasound scanning. The patient age in cancellation group was older than that of normal and low response groups. The AFC in low response and cancellation groups was less marked than normal response group. Basal FSH level in low response and cancellation groups was higher than that in normal response group. Basal E2 level was not statistically different among these three groups. Numbers of oocytes matured, embryos replaced and clinical pregnancy rate, and delivery rate in normal response group were more marked and higher than those in low response group. There was no significant difference in embryo implantation rate in normal and low response group. When the multi-logistic regression method was performed, the AFC and basal FSH were significantly associated with the number of oocytes retrieved, age and AFC were significantly associated with clinical pregnancy. The AFC and basal FSH are better predictors of ovarian response in IVF patients ≥35 years of age. The AFC with age was predictor factors of clinical pregnancy after IVF.