卵泡敏感指数评估体外受精/卵胞质内单精子显微注射患者的卵巢反应性

Assessment of ovarian response in in vitro fertilization/intracytoplasmic sperm injection patients by follicular sensitivity index

目的探讨卵泡敏感指数(follicular sensitivity index,FSI)对接受体外受精(in vitro fertilization,IVF)/卵胞质内单精子显微注射(intracytoplasmic sperm injection,ICSI)患者卵巢反应性的预测价值。方法回顾性队列研究分析2009年4月—2015年12月期间苏北人民医院生殖中心选择长方案促排卵治疗,行IVF/ICSI-胚胎移植(embryo transfer,ET)的不孕症妇女的资料,共纳入1354个取卵周期,分析FSI等因素与获卵数之间的相关性,把FSI按照三分位法共分为低FSI组(n=452)、中FSI组(n=451)、高FSI组(n=451),分别统计3组患者基本临床特征、控制性超促排卵(COH)周期资料及实验室资料等。结果促性腺激素(Gn)使用总量、体质量指数(BMI)、年龄和不孕年限与获卵数呈负相关,卵泡输出率(FORT)、窦卵泡数(AFC)、FSI、排卵前卵泡数(PFC)、卵巢敏感指数(OSI)与获卵数呈正相关,3组间比较差异均有统计学意义(P 均<0.05)。OSI、FORT、FSI与基础卵泡刺激素(FSH)/黄体生成素(LH)比值、不孕年限、年龄、BMI、Gn使用总量、Gn使用时间呈负相关,与获卵数呈正相关,且相关系数 rOSI>rFSI>rFORT。患者不孕年限、平均年龄、BMI、基础FSH/LH比值、基础PRL水平、FSH启动剂量、FSH总用量、人绝经期促性腺激素(hMG)用量、Gn使用时间、Gn使用总量、获卵数、OSI、FORT 3组间比较差异有统计学意义(P<0.05)。结论FSI值与患者卵巢反应性有一定相关性, FSI高者卵巢反应性高。

Objective To investigate the value of follicular sensitivity index (FSI) in evaluating ovarian response in patients receiving in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods This present retrospective cohort study included infertility women who choosed a long-term program to promote ovulation treatment, and underwent IVF/ICSI-embryo transfer (ET) from April 2009 to December 2015 in the Reproductive Center of the People’s Hospital of Northern Jiangsu Province. Totally 1354 oocyte retrieval cycles were included, the correlation was analyzed between factors such as FSI and the number of oocytes retrieved, and the patients were divided into three groups: low FSI group (n=452), medium FSI group (n=451) and high FSI group (n=451) according to the tertile method. The basic clinical characteristics, controlled ovarian hyperstimulaiton (COH) cycle data and laboratory data of the three groups were statistically analyzed. Results The total dosage of gonadotropin (Gn) used, body mass index (BMI), age, infertility duration and the number of oocytes retrievaled were negatively correlated. Follicular output rate (FORT), antral follicles count (AFC), FSI, preovulatory follicles (PFCs) and ovarian sensitivity index (OSI) were positively correlated with the number of oocytes retrieved. The differences among the three groups were statistically significant (P<0.05). OSI, FORT, FSI were negatively correlated with factors like basal follicle stimulating hormone(FSH)/luteinizing hormone(LH) ratio, infertility duration, age, BMI, total dosage and duration of Gn used, and positively correlated with the number of oocytes retrieved, and the correlation coefficient was rOSI>rFSI>rFORT. Infertility duration, age, BMI, basal FSH/LH ratio, basal prolactin (PRL) level, FSH starting dosage, total FSH dosage, human menopausal gonadotropin(hMG) dosage, duration of Gn used, total Gn dosage, the number of oocytes retrieved, OSI and FORT were statistically significant among the three groups (P<0.05). Conclusion FSI value has a certain correlation with ovarian reactivity, and patients with high FSI have high ovarian response.