卵巢间质动脉血流动力学指标预测体外受精周期卵巢反应性的价值

Value of hemodynamics parameters of ovarian interstitial artery in predicting ovarian reactivity during in vitro fertilization cycles

目的探讨卵巢间质动脉血流动力学指标预测体外受精周期卵巢反应性和最佳时间点。方法选取68例因不孕症行体外受精控制性超促排卵治疗的患者,分别收集其周期降调日、周期第1天、第7天、第10天及人绒毛膜促性腺激素(hCG)注射日卵巢间质动脉血流动力学指标,包括收缩期最大血流速度(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)、阻力指数(RI)及收缩期最大血流速度与舒张末期血流速度的比值(S/D)。根据hCG注射日血清雌二醇(E2)水平和获卵数分为卵巢低反应组12例(E2<5000ρmol/L,获卵数≤5个)、卵巢正常反应组38例(E25000~18350ρmol/L,获卵数6~15个)及卵巢高反应组18例(E2>18350ρmol/L或获卵数>15个),分析各组患者不同监测时间点卵巢间质动脉血流动力学指标的差异;探讨各指标与获卵数、受精数及优胚数的相关性。结果周期第1天,高反应组卵巢间质动脉PI、RI、S/D均低于低反应组,PSV和EDV均高于低反应组(均P<0.05);与正常反应组比较,各指标差异均无统计学意义。在周期降调日、周期第7天、第10天及hCG注射日,各组卵巢间质动脉血流动力学指标比较差异均无统计学意义。周期第1天,PI、RI及S/D与获卵数、受精数及优胚数均呈负相关(均P<0.05),而PSV和EDV与获卵数、受精数及优胚数均呈正相关(均P<0.05);其余时间点卵巢间质动脉血流动力学指标与获卵数、受精数及优胚数均无相关性。结论控制性超促排卵周期第1天检测卵巢间质动脉血流动力学指标可有效评估患者卵巢反应性,有助于早期预测体外受精患者获卵数、受精数及优胚数。

Objective To explore the value of hemodynamics parameters of ovarian interstitial artery in predicting ovarian reactivity and the optimal time point.Methods A total of 68 infertile patients treated with controlled ovarian hyperstimulation(COH)were enrolled in this study.The hemodynamic parameters of ovarian interstitial artery including peak systolic velocity(PSV),end-diastolic velocity(EDV),pulsatility index(PI),resistance index(RI)and the ratio of peak systolic velocity to end-diastolic velocity(S/D)on the day of pituitary down-regulation,day 1,day 7,day 10 and the day of hCG injection were collected.The patients were divided into three groups according to the level of serum estradiol(E2)on the day of hCG injection and oocyte retrieval number as the following.Low ovarian response group(E2<5000ρmol/L,oocyte retrieval number≤5,n=12),normal ovarian response group(E25000~18350ρmol/L,oocyte retrieval number 6~15,n=38),and high ovarian response group(E2>18350ρmol/L,oocyte retrieval number>15,n=18).The differences of the parameters mentioned above at different time points among groups of high,normal and low ovarian response were analyzed.In addition,the correlation among the parameters and the number of fertilized oocytes,number of oocytes retrieved and number of high-quality embryos were also analyzed.Results Compared with the low-response group,PI,RI,and S/D of ovarian interstitial artery at day 1 were lower in the high-response group,while PSV and EDV were higher in the high-response group(all P<0.05),compared with normal response group,there were no significant difference.There were no significant differences among the three groups of the parameters measured at the day of pituitary down-regulation,day 1,day 7,day 10 and the day of hCG injection.Moreover,PI,RI,and S/D measured at day 1 were negatively related to the number of fertilized oocytes,number of oocytes retrieved and number of high-quality embryos(all P<0.05),while PSV and EDV were positively related to above parameters(all P<0.05).There were no correlation among follicle monitoring outcome indicators and the parameters measured at other time points.Conclusion The ovarian interstitial artery hemodynamic parameters measured at COH day 1 can evaluate the ovarian response effectively.It is also helpful for the early prediction of the number of fertilized oocytes,number of oocytes retrieved and number of high-quality embryos during IVF cycles.