卵巢储备指标对卵巢低反应及临床妊娠的预测价值

Predictive Value of Ovarian Reserve Testings on Poor Ovarian Response and Clinical Pregnancy

【目的】探讨卵巢储备指标（AMH、AFC、b FSH、b E2及年龄）在各种不孕因素女性中对卵巢低反应及临床妊娠的预测价值。【方法】回顾性分析7 959个IVF或ICSI周期,包括输卵管因素不孕3 366个周期、子宫内膜异位症315个周期、女方排卵障碍1 359个周期、男方因素1 160个周期、双方因素1 497个周期及不明原因不孕262个周期。以卵巢低反应（获卵数≤3个）及临床妊娠为结局变量,对各不孕因素患者行ROC曲线分析。【结果】1卵巢储备指标预测卵巢低反应的ROC曲线分析：7 959个周期中,各指标ROC曲线下面积（AUC）分别为：AMH 0.90,AFC 0.84,年龄0.75,b FSH 0.71,b E2为0.58。AMH的AUC大于联合各指标的AUC（0.90 vs 0.89）。除外不明原因不孕,在其他各种不孕因素患者中：AMH的AUC范围在0.84~0.92,均大于其他指标。不明原因不孕患者的年龄的AUC为0.9,AMH无意义（AUC 0.98,95%CI 0.93-1.02）。2卵巢储备指标预测临床妊娠的ROC曲线分析：所有周期中,年龄的AUC大于AFC及AMH（0.62 vs 0.60 vs 0.58）。联合年龄＋AFC的AUC（0.63）大于其他联合指标。但在子宫内膜异位症患者仅年龄可预测临床妊娠（AUC 0.65,95%CI 0.58-0.72）;排卵障碍患者的AFC、AMH的AUC大于年龄（0.65 vs 0.64 vs 0.59）;不明原因不孕者各指标均无意义。【结论】对于预测卵巢低反应：除外不明原因不孕的患者,AMH与AFC预测卵巢低反应的价值高于其他指标;且使用AMH优于联合使用各指标。对于预测临床妊娠：年龄的预测价值最高,且年龄＋AFC的预测价值高于其他联合指标。子宫内膜异位症患者仅年龄能预测临床妊娠。排卵障碍患者用AFC、AMH预测临床妊娠优于其他指标。

【Objective】 To explore the predictive value of ovarian reserve testings（AMH / AFC / b FSH / b E2 / age） on poor ovarian response and clinical pregnancy among females in different factors of infertility. 【Methods】 A total of 7 959 cycles of IVF / ICSI including 3 366 cycles of tubal infertility, 315 cycles of endometriosis, 1 359 cycles of ovulatory dysfunction, 1 160 cycles of male factor infertility, 1 497 cycles of couple ＇s factor infertility and 262 cycles of unknown infertility were included in this retrospective study. Poor ovarian response（oocytes retrived ≤3） and clinical pregnancy were the outcome variables in ROC analysis. 【Results】 1ROC analysis of ovarian reserve testings on poor ovarian response ： among the 7959 cycles, the AUC of every testing were as follows ：AMH 0.90, AFC 0.84,age 0.75,b FSH 0.71,and b E2 0.58.The AUC of AMH was more than combined testings（0.90 vs 0.89）.Among the various factors of infertility, the AUC range of AMH was 0.84-0.92 and was more than other testings. In unknown infertility,the AUC of age was 0.9, but AMH had no predictive value（AUC 0.98,95%CI 0.93-1.02）. 2ROC analysis of ovarian reserve testings on clinical pregnancy ： generally, the AUC of age was more than AFCand AMH（0.62 vs 0.60 vs 0.58）. The AUC of age combined with AFC（0.63） was more than other combing testings. Only age had predictive value on pregnancy in endometiosis（AUC 0.65,95%CI 0.58-0.72）. The AUC of AFC and AMHwas more than that of age in ovulatory dysfunction patients（0.65 vs 0.64 vs 0.59）. No siginificant testing was found on predicting clinical pregnancy among unknown infertility patients. 【Conclusion】 AMH and AFC had more value in predicting poor ovarian response except in unknown infertility patients, and AMH was better than combining testings. Age had more value than other testings in predicting clinical pregnancy, and it was better combining age and AFC than other testings. Only age had predictive value on pregnancy in endometiosis. AFC and AMH had more value on pregnancy in ovulatory dysfunction patients.