提高卵巢功能正常患者促排卵治疗卵巢反应性预测准确率:一项诊断试验研究

Improving the Prediction of Ovarian Response to Ovulation Induction in Patients with Normal Ovarian Function: A Diagnostic Trial

目的:探讨促排卵治疗中卵巢反应性预测准确率较高的指标。方法:回顾性分析2014年6月—2016年12月于北京大学第三医院生殖医学中心实施体外受精/胞浆内单精子注射(IVF/ICSI)治疗患者的基本信息、用药情况及治疗结局,共5 859个IVF/ICSI周期,用于建立Logistic回归模型预测卵巢反应性,其中低反应组517个周期,正常反应组4 061个周期,高反应组1 281个周期。2017年1—12月患者的临床资料共1 143个周期作为诊断试验用于验证。结果:3组的年龄、窦卵泡数(AFC)、基础血清激素水平、促排卵药物使用情况及临床结局差异均有统计学意义(P<0.001)。血清抗苗勒管激素(AMH)是卵巢反应性的重要预测因素,预测高反应及低反应Cut-off值分别为2.76 ng/mL、1.50 ng/mL,结合年龄可更好地预测卵巢高反应,参考AFC可预测卵巢低反应的发生。结论:血清AMH是促性腺素(Gn)启动前预测卵巢反应性较好的指标,联合AFC和年龄对取得适当数量卵细胞、获得良好的妊娠结局及预防卵巢过度刺激综合征具有较大意义。

Objective：To invesligale the high-accuracy predictive factors of ovarian response to ovulation induction. Methods：The basic information, medication and outcome of 5 859 IVF/ICSI cycles were respectively analyzed in our center from June 2014 to December 2016. The Logistic regression model was developed to predict the ovarian response. There were a total of 517 cycles in the low-response group, 1 281 cycles in the high- response group and 4 061 cycles in the normal-response group. The clinical data of 1 143 cycles in 2017 were used to test the diagnostic value of those factors. Results：The difterences in the age, AFC, basal hormone levels, medication and clinical outcomes were significant among the three groups （P〈0.001）. The level of serum AMH was the important predictor of ovarian response, with the cut-off values of 2.76 ng/mL for high ovarian response and 1.50 ng/mL for low ovarian response. AMH if combining with age could predict high ovarian response, while AMH combining with AFC also predict low ovarian response. Conclusions：The level of sermn AMH was a good predictor of ovarian response before Gn initiation. AMH if combining with AFC and age was of great significance in obtaining an appropriate number of oocytes, ensuring a good pregnancy outcome and preventing ovarian hyperstimulafon syndrome.