经阴道彩色多普勒超声技术预测卵巢在体外受精-胚胎移植过程中的反应性

Evaluation of ovarian responsibility of in vitro fertilization-embryo transfer with transvaginal color Doppler sonography

目的探讨经阴道彩色多普勒超声（TV-CDS）预测接受体外受精-胚胎移植（IVF-ET）患者卵巢反应性的价值。方法选择接受IVF-ET的83例不孕症患者,根据获卵数分为低反应组（获卵数≤5个）、正常反应组（获卵数6~15个）和高反应组（获卵数〉15个）。采用TV-CDS测量月经周期第3天（d3）和人绒毛膜促性腺激素（hCG）注射日（hCG日）的卵巢总体积、窦卵泡数（AFC）、卵巢间质血流搏动指数（PI）、阻力指数（RI）、动脉收缩期峰值流速/舒张末期血流速度比值（S/D）、收缩期最大血流速度（PSV）、舒张末期血流速度（EDV）值,分析上述指标对卵巢反应性的预测价值。记录并比较三组间的卵巢间质血流参数和卵子数、获卵数、受精卵数和优质胚胎数。结果高反应组卵巢体积显著大于低反应组和正常反应组,三组间AFC、MⅡ卵子数、受精卵数、优质胚胎数差异均有统计学意义;低反应组与高反应组d3的PI、RI、S/D、PSV和EDV间差异有统计学意义。卵巢体积及AFC与获卵数、MⅡ卵子数、受精卵数呈正相关;d3 PI、RI、S/D与获卵数呈负相关,d3 PSV、EDV与获卵数呈正相关。结论 AFC、卵巢总体积、d3卵巢间质血流对预测卵巢反应性有一定价值。

Objective To explore the application value of transvaginal color Doppler sonography（TV-CDS） in predicting ovarian responsibility of in vitro fertilization-embryo transfer（IVF-ET） in vitro.Methods A total of 83 infertile women who underwent IVF-ET were divided into poor-response group（≤5 oocytes）,normal-response group（6—15 oocytes） and high-response group（15 oocytes） according to the number of retrieved oocytes.Meanwhile,the ovarian volume,total number of antral follicles,pulsatility index（PI）,resistance index（RI）,peak systolic velocity/end diastolic velocity（S/D）,peak systolic velocity（PSV） and end diastolic velocity（EDV） of ovarian stromal arterial blood flow were measured with TV-CDS on the third day of menstruation（d3） prior to controlled ovarian hyper-stimulation and the day of hCG administration.All the blood flow parameters of the ovarian stromal artery and the number of oocytes,MⅡ oocytes,fertilized eggs and good quality embryos were calculated and compared among three groups.Results The ovarian volume was significantly higher in high-response group than that in normal and poor response groups.There were significant differences of AFC,MⅡ oocytes,fertilized eggs and good quality embryos among three groups,as well as of PI,RI,S/D,PSV,EDV on d3 between poor-response group and high-response group.Ovarian volume and AFC were positive correlated with the number of retrieved oocytes,mature oocytes and fertilized eggs.On d3,PI,RI and S/D correlated negatively and PSV,EDV correlated positively with the number of retrieved oocytes.Conclusion The ovarian volume,AFC,PI,RI,S/D,PSV,EDV of ovarian stromal blood flow have great value in predicting ovary responsibility.