体外受精-胚胎移植309个卵巢反应不良周期临床分析

Clinical analysis on 309 cases of poor ovarian response in in vitro fertilization-embryo transfer

目的探讨体外受精-胚胎移植周期中卵巢反应不良的影响因素、预测及处理。方法2005年我们完成取卵周期2352个,其中274例患者309个周期发生卵巢反应不良,选择与其同一日取卵且时间接近的309个周期作为对照,比较两组既往卵巢手术史、促性激素的用量和时间、受精率、妊娠率、流产率、卵巢储备能力预测的指标以及卵巢反应不良组妊娠结局的预测。结果卵巢反应不良组患者年龄、既往卵巢手术史、促性激素的用量和时间均高于对照组(P<0.001),而受精率、妊娠率显著低于对照组(P<0.0001)。在卵巢储备能力预测方面,年龄、基础卵泡刺激素(BFSH)、基础卵泡刺激素/黄体生成素(BFSH/LH)、窦卵泡数(AFC)两组均有明显差异(P<0.001)。在卵巢反应不良组中,年龄≤40岁者妊娠率为25.4%,而年龄>40岁者妊娠率为1.4%,精确fisher概率法比较差异有显著性(P<0.0001);在妊娠结局的预测方面,对年龄、BF-SH、LH、BFSH/LH、AFC、基础雌二醇(E2)进行回归分析,年龄是首先被引入(OR,0.831;95%可信区间,0.765～0.910;P=0.000),其次是AFC(OR,1.300;95%可信区间,1.025～1.648;P=0.031)。结论既往有卵巢手术史者与卵巢反应不良密切相关;对卵巢反应不良的患者,综合年龄、FSH、BFSH/LH、AFC可以预测卵巢储备能力;卵巢反应不良妇女IVF妊娠率较低,尤其对年龄>40岁卵巢反应不良的患者,IVF-ET的成功率极低;在妊娠结局的预测方面,年龄、窦卵泡数与妊娠结局密切相关。

Objective To explore the validity of predictor of ovarian reserve; to investigate the related factors and management of poor ovarian response in in vitro fertilization - embryo transfer （IVF - ET）. Methods A total of 2352 retrieval oocyte cycles have been completed in 2005. Poor ovarian response was observed in 274 patients of 309 cycles undergoing IVF. Another 309 cycles at the same retrieve oocyte period were selected as the control group. The outcome of IVF - ET and the common markers of ovarian reserve were compared between the two groups. Results The group with poor ovarian response presented significant difference from the control group in age, ovarian surgeries, gonadotrophin usage, fertilization rate and pregnancy rate. No statistically significant difference in abortion rate was found between the two groups （13.8% vs 7.3%, P〉0. 05）. The clinical pregnancy rate declined significantly in women older than 40 years than age 440 years （1.4% versus 25.4%, P〈0. 001）. We found significant differences in age, basal FSH, FSH -to- LH ratio and the antral follicle count between the two groups （P〈 0. 001）. Multivariate logistic regression analysis was applied to study the relationship among age, BFSH, AFC, BFSH/LH, E2 and clinical pregnancy, and the age and AFC were variable selected. Conclusions Previous ovarian surgery is associated with poor ovarian responses. The age, basal FSH, FSH -to- LH ratio and AFC are the predictor of ovarian reserve. The pregnancy rate is low of poor ovarian responses women in IVF - ET, and the decline in clinical pregnancy rate of women aged〉40 years became accelerated. The chronological age and the AFC significantly improved the prediction of clinical pregnancy of poor ovarian response.