降调节前后常用指标预测控制性超排卵中卵巢反应性的临床价值探讨

Predictive value of multiple predictors before and after down-regulation in the ovarian response on controlled ovarian hyperstimulation

目的探讨垂体降调节前后常用指标预测控制性超排卵(COH)中卵巢反应性的临床价值。方法回顾性分析2012年2月至9月在我中心行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗符合入选标准的116个周期。降调前月经来潮第3天和降调第14天检测卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)、抗苗勒管激素(AMH)、窦卵泡计数(AFC),分析这些指标与获卵数的关系。结果 (1)控制年龄因素后与获卵数的偏相关系数为:基础AMH 0.350、降调后AMH 0.357,基础AFC 0.456、降调后AFC 0.547,(P均<0.001);基础FSH/LH-0.189(P<0.05);其余各指标(P均>0.05)。(2)预测卵巢低反应时ROC曲线下面积(area under ROC curve,AUC)>0.7的评价指标只有年龄、基础AMH、降调后AMH、基础AFC、降调后AFC,其他各指标AUC<0.7。预测卵巢高反应时AUC>0.7的评价指标有基础AMH、降调后AMH、基础AFC、降调后AFC,其他各指标AUC<0.7。(3)相关性分析显示,AMH、AFC两个指标在降调后的相关系数大于降调前。无论是对卵巢低反应的预测还是对卵巢高反应的预测,AMH、AFC两个指标在降调后的Youden指数均大于降调前。结论 AMH和AFC均为预测卵巢反应性较为准确的指标。预测COH中卵巢反应性时,在重视基础日检测值的同时,也要重视降调后检测指标的预测价值。

Objective： To investigate predictive value of multiple predictors before and after down-regulation in the ovarian response on controlled ovarian hyperstimulation （COH）. ~ Methods： The data of 116 cycles in accordance with inclusion criteria for in vitro fertilization/ intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET） were retrospectively analyzed in our center from February to September 2012. Serum FSH, LH, E2, anti-Mallerian hormone （AMH） and antral follicle count （AFC） were measured at baseline and Day 14 after using gonadotrophin-releasing hormone agonist （GnRH-a）. The relationship between the predictors and the number of oocytes retrieved was analyzed. Results： （1） After controlling the factor of age, partial correlation coefficient with the number of oocy＇tes retrieved for baseline AMH was 0. 350, AMH after down-regulation 0. 357, baseline AFC 0. 456,AFC after down-regulation 0. 547 （all P〈0. 001）, baseline FSH/LH-0. 189 （P〈0.05）. The rest of the predictors were not significantly different （P〉0.05）. （2） To predict poor ovarian response, the predictors of area under ROC curve （AUC）〉0.7 were age, baseline AMH, AMH after down-regulation, baseline AFC, AFC after down-regulation, and other predictors were for AUC〈0. 7. To predict high ovarian response, the predictors of AUC〉0. 7 were baseline AMH, AMH after down-regulation, baseline AFC,AFC after down-regulation and other predictors were for AUC〈0.7. （3） Correlation analysis showed that the correlation coefficient between AMH and AFC after down-regulation was greater than before down-regulation. The Youden index of AMH or AFC after down-regulation was higher than before down- regulation, no mater for predicting poor ovarian response or high ovarian response. Conclusions： AMH and AFC are accurate predictors of ovarian response. The predictors after down- regulation are as important as the baseline predictors in the prediction of ovarian response on COH.