抗苗勒管激素联合三维超声卵巢血管成像预测超排卵周期中多囊卵巢综合征反应性

Prediction of ovarian response of polycystic ovary syndrome in patients with controlled ovarian hyperstimulation by the serum AMH level and power Doppler angiography

目的探讨体外受精与胚胎移植(IVF-ET)超排卵(COH)周期中抗苗勒管激素(AMH)联合三维超声卵巢血管成像预测多囊卵巢综合征(PCOS)的反应性的价值。方法选择2013年8月至2014年9月行黄体中期长方案超排卵PCOS患者40例为研究对象,根据COH后E2水平和获卵数分为2组:卵巢正常反应组(23例)和卵巢高反应组(15例)。比较两组的临床资料、IVF参数、AMH、三维超声指数并分析这些指标与卵巢反应的相关性。结果卵巢高反应组与正常反应组之间的血管指数(VI)、血流指数(FI)、血管血流指数(VFI)的差异无统计学意义(P>0.05);卵巢高反应组窦卵泡数、平均卵巢体积、D3天AMH浓度明显高于卵巢正常反应组,差异有统计学意义(P<0.05);logistic回归分析和ROC曲线分析显示:D3天AMH浓度、窦卵泡数可以预测卵巢的反应性(P<0.05);平均卵巢体积、血管指数(VI)、血流指数(FI)、血管血流指数(VFI)与卵巢的反应性无相关性(P>0.05)。结论 PCOS卵巢高反应患者的三维能量多普勒超声卵巢血流指数没有增加,不能预测卵巢反应性,而其窦卵泡数和AMH浓度明显增加,与卵巢的反应性相关,可以作为卵巢反应的预测指标。

Objective： To explore the role of the serum AMH level and power Doppler angiography in the prediction of ovarian response of polycystic ovary syndrome in patients with controlled ovarian hyperstimulation in vitro-fertiliazation embryo transfer （IVF-ET） cycles. Methods： 40 patients with polycystic ovary syndrome accepted with amid-luteal phase long protocol treatment from August 2013 to September 2014 were enrolled in the study. All subjects were divided into two groups according to the estradiol level and the number of oocytes retrieved： high ovarian response （15 cases） and normal ovarian response （23 cases ） . Data analysis was carried out on the patients＇ clinical information, IVF outcomes, AMH and power Doppler angiography parameters. Results： The ovarian VI, FI and VFI were similar in both high and normal responders （P〉0.05） . AFC, OV and D3 AMH level were significantly higher in women who developed high responder than in normal responders （P〈0.05） . AFC and D3 AMH level were significant predictors of high response on multiple regression and receiver operating characteristic （ROC） curve analysis （P〈0.05） . There were no correlation between ovarian OV, VI, FI, VFI and ovarian response （P〉0.05） . Conclusions： Ovarian blood flow, as measured by 3D ultrasound, is not increased in women with PCOS who demonstrate a high response to ovarian stimulation and is not predictive of high response during IVF treatment. AFC and D3 AMH level were increased in high ovarian responders which could be good predictor of high response in patients with PCOS.