Anti-Müllerian hormone and antral follicle count predict ovarian response in women less than 45 years following GnRH antagonist multiple-dose protocol

Objective:To speculate which of the following parameters:antral follicle count(AFC),anti-Müllerian hormone(AMH),follicle-stimulating hormone(FSH)and age can be used as a predictor of ovarian response to gonadotropin-releasing hormone(GnRH)antagonist stimulation multiple-dose protocol in women under 45 years,and to determine the cutoff value of these parameters and their correlations for predicting low and high ovarian response.Methods:This prospective study included 462 women with the mean age of(29.3±6.5)years.All women were subjected to the GnRH antagonist stimulation multiple-dose protocol.On the second day of the menstrual cycle,ultrasonography was conducted to determine AFC in both ovaries.Peripheral blood samples were collected to evaluate the level of estradiol,FSH,luteinizing hormone,prolactin,thyroid-stimulating hormone,and AMH.The women were divided into three groups:low response(AHH<1 ng/mL,n=173),normal response(AMH=1.0-3.5 ng/mL,n=175),and high response(AMH>3.5 ng/mL,n=114).Results:A significant decrease was found in the age and FSH level in the high response group compared to other groups(P<0.001).Conversely,a significant increase was shown in AMH,estradiol on human chorionic gonadotropin(hCG)day,AFC,mature oocytes,fertilized oocytes,and embryos transferred in the high response group compared to the other two groups(P<0.001).The receiver operating characteristic(ROC)curves demonstrated that AFC and AMH had the highest accuracy,followed by basal FSH level and age in the prediction of low ovarian reserves(P<0.001)with cutoff values of≤4.50 and≤0.95 for AFC and AMH,respectively.Moreover,the ROC analysis showed that AFC had the highest accuracy,followed by AMH level and age in the prediction of high ovarian reserves with a cutoff value of≥14.50,≥3.63,and≤27.50 years,respectively(P<0.01).A significant decrease was observed in women's age,estradiol level,and oocyte fertilization rate in pregnant women compared to non-pregnant women(P<0.001).Additionally,significant negative correlations were found between the AFC,the number of mature oocytes,fertilized oocytes,embryos transferred,and the age of pregnant women(P<0.001).Conclusions:AFC and AMH predict low and high ovarian response to GnRH antagonist stimulation multiple-dose protocol in women under 45 years.

Elective oocyte freezing for the preservation of fertility

Oocyte cryopreservation has recently emerged as an option for women to preserve their fertility for medical (e.g. treatable malignancy) or elective indications (e.g. advancing age). This report describes an IRB-approved study of over 200 oocyte cryopreservation cycles at one center. Patients presenting for oocyte cryopreservation (January 2005 to 2010) were analyzed for day 3 follicle stimulating hormone (FSH), basal antral follicle count (BAFC), gonadotropin usage and the number of oocytes retrieved and cryopreserved. New patient consultations were performed on 516 women, of whom 175 (34%) proceeded to initiate a total of 233 cryopreservation cycles. Twenty-four cycles were cancelled (10%) after starting follicular stimulation due to poor ovarian response or self-withdrawal of the patients. Patients whose cycles were cancelled demonstrated a higher Day 3 FSH and a lower BAFC than patients who completed cycles (p < 0.01). In the 209 completed cycles, the most important predictors of a successful cycle included BAFC (r = 0.36), FSH (r = –0.25) and age (r = –0.18) with the mean number of oocytes cryopreserved at 13.6 ± 8.8. Information about long-term fertility preservation must reach both patients and health care providers so that more women can be educated about the benefits of proactive early physiological reproductive assessment and possible interventions available.

Effect of Diane-35 on Polycystic Ovarian Syndrome of Different Subtypes

Objective: To explore the effect of Daine-35 on serum hormone and antral follicle count of different subtypes of polycystic ovarian syndrome (PCOS). Methods: 138 cases of PCOS were recruited and typed according to Rotterdam diagnostic criteria;78 cases of tubal infertility without hyperandrogenism and menstrual disorders during the same period were collected as control. Serum reproductive hormones including follicle-stimulating hormone (FSH), luteotropic hormone (LH), prolactin (PRL), estradiol (E2), dehydroepiandrosterone (DHEAS), total testosterone (TT) and fast insulin (INS) were determined by chemiluminescent immunoassay. Ovarian antral follicle count was determined by ultrasonography. The effects on above indexes were evaluated for different subtypes of PCOS after 3 cycles of treatment with Daine-35. Results: The cases of Type A and Type B were respectively 43 (31.2%) and 73 (52.9%). They were the most common clinical phenotypes of PCOS in the central region ofChina. Total testosterone (TT) and DHEAS levels of Types A, C and D were higher than those of the control group (p < 0.05). The LH, LH/FSH, INS and HOMA-IR levels in all types of PCOS were higher than those of the control group (p < 0.05). Antral follicle counts of Types A, B and D were more than those of Type C and the control group (p < 0.05). After treatment with Daine-35 for 3 cycles, the serum TT levels of Types A, C and D decreased (p < 0.05). DHEAS values also decreased, but not significantly (p > 0.05). The serum LH and LH/FSH as well as the antral follicle count of all the PCOS types significantly decreased (p < 0.01). Conclusion: Type A and Type B are the most common clinical phenotypes of PCOS in the central region of China. Taking Daine-35 for 3 cycles can significantly reduce the serum androgen, serum LH, LH/FSH ratio, and antral follicle count of different PCOS types.

多囊卵巢综合征患者血清抗米勒管激素和窦卵泡计数水平与卵巢储备功能下降的相关性

目的 探究多囊卵巢综合征(PCOS)患者血清抗米勒管激素(AMH)和窦卵泡计数(AFC)水平及其与卵巢储备功能下降(DOR)发生风险的相关性。方法 选择2021年8月至2022年8月于四川绵阳四○四医院就诊的173例PCOS患者,根据血清卵泡刺激素(FSH)或雌二醇(E_(2))水平,将PCOS患者分为DOR组(45例)和非DOR组(128例),比较两组患者的一般资料及生化指标、AMH和AFC水平及卵巢储备功能相关指标。采用Pearson检验分析PCOS合并DOR患者中AMH、AFC与卵巢储备功能指标的相关性,构建PCOS患者发生DOR的列线图预测模型,并评估其预测效能及准确度和有效性。结果 DOR组患者的AMH、AFC水平明显低于非DOR组,年龄、黄体生成素(LH)、FSH、FSH/LH、E_(2)、睾酮(T)明显高于非DOR组(t=7.417、10.598、2.681、24.222、7.801、11.334和156.602,P<0.05),AMH、AFC分别与FSH、LH、FSH/LH、T呈显著负相关,与E_(2)呈显著正相关(r=-0.574、-0.566、-0.547、-0.528和0.496;t=-0.631、-0.584、-0.603、-0.560和0.545,P<0.05),列线图模型的受试者工作特征(ROC)曲线下面积为0.802(0.764~0.840),灵敏度和特异度分别为85.42%、74.05%。结论 PCOS患者血清AMH和AFC水平与卵巢储备功能相关指标具有明显相关性,与DOR的发生密切相关,对预测PCOS患者发生DOR具有较高价值。

滋肾益经活血汤治疗肾虚血瘀型卵巢储备功能减退的疗效及对T淋巴细胞亚群水平的影响

目的:探讨滋肾益经活血汤治疗肾虚血瘀型卵巢储备功能减退(DOR)的疗效及对T淋巴细胞亚群水平的影响。方法:选取2019年4月至2022年4月陕西省中医医院收治的肾虚血瘀型DOR患者120例作为研究对象,按照随机数字表法随机分为观察组和对照组,每组60例。对照组接受戊酸雌二醇环丙孕酮片治疗,观察组在对照组基础上接受滋肾益经活血汤治疗。治疗6个月经周期后,比较2组患者临床疗效和治疗后中医证候积分、窦卵泡计数(AFC)、卵巢动脉血流参数、促卵泡激素(FSH)、雌二醇(E_(2))、抗米勒管激素(AMH)、月经情况、T淋巴细胞亚群水平及不良反应发生率。结果:治疗后,观察组治疗总有效率为88.33%(53/60)高于对照组的71.67%(43/60),差异有统计学意义(P<0.05)。治疗前,2组中医证候积分、AFC、FSH、E_(2)、AMH、卵巢动脉血流参数、月经情况和T淋巴细胞亚群水平比较,差异无统计学意义(P>0.05);治疗后,观察组中医证候积分、FSH、CD8^(+)、阻力指数和月经周期、月经色质、月经量、经期评分低于对照组,AFC、舒张末期流速、收缩期峰值速度、E_(2)、AMH、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组,差异有统计学意义(P<0.05)。2组患者不良反应率比较,差异无统计学意义(P>0.05)。结论:滋肾益经活血汤治疗肾虚血瘀型DOR疗效显著,能有效改善患者临床症状、卵巢储备功能、月经异常和免疫功能,且不良反应较少。

探讨对卵巢储备功能采取AMH及AFC计数预测的价值

目的 探讨对卵巢储备功能采取AMH和AFC计数进行预测的价值。方法 回顾性分析本院2022年1月—2023年6月妇科门诊接诊的90例患者作为研究对象,按照卵巢储备功能的差异分为对照组(卵巢功能正常)和观察组(卵巢功能减退),每组45例,对两组患者的抗缪勒管激素(AMH)、窦卵泡数(AFC)、雌二醇(E2)、促卵泡生成素(FSH)及FSH与促黄体生成素(LH)的比值(FSH/LH)进行对比,并以Logistic二元回归分析对具有统计学差异的指标与卵巢储备功能的相关性进行分析。结果 两组在AMH和AFC指标方面的差异存在统计学意义(P<0.05),对两项指标与卵巢储备功能的相关性进行分析,发现AMH、AFC是影响患者卵巢储备功能的关键指标。ROC分析结果提示AMH、AFC联合进行卵巢储备功能预测时,敏感度为88.90%,特异度为88.89%。结论 AMH和AFC计数在卵巢储备功能早期评估及预测方面具有良好的价值。

Rejuvenation of Ovary and Thin Endometrium by Autologous PRP Injection in POR and Recurrent Implantation Failure

In India, the problem of infertility is growing and in the last 5 years, it has gone up to 20% - 30%. This ongoing prospective clinical study brings forth a novel, innovative, effective, simple, affordable, easily performed outpatient procedure (OP) and a promising therapeutic method in rejuvenating the Ageing Ovaries and Thin Endometrium, with autologous Platelet Rich Plasma (PRP). This clinical study proves to give a better result in rejuvenating Ovary and treating the Thin Endometrium. This pilot study included five women (28 - 44 years) with Poor Ovarian Response (POR), Premature Ovarian Insufficiency (POI) and Perimenopause and Thirty-nine women (22 - 43 years.) with recurrent implantation failure due to Thin Endometrium were subjected to autologous PRP instillation under Ultrasound Guidance, and Hysteroscopic guided PRP. After PRP, a significant output was obtained, with improved Anti Mullerian Hormone (AMH) and Antral Follicle Count (AFC) and out of five women three women conceived by Intra Cytoplasmic Sperm Injection (ICSI). PRP injected in women with Poor Ovarian Response found successful ovarian rejuvenation within 1 - 3 months and had a 60% of pregnancy rate, PRP into the endometrium had 53.8% successful pregnancies. We have not encountered any complications.

Anti-Müllerian hormone, antral follicle count and folliclestimulating hormone for predicting the number of oocytes retrieved in IVF/ICSI cycles

Objective To evaluate the efficacy of anti-Müllerian hormone（AMH）, antral follicle count（AFC） and follicle-stimulating hormone（FSH） for predicting the number of oocytes retrieved in in-vitro fertilization/intracytoplasmic sperm injection（IVF/ICSI）cycles.Methods In this retrospective study, a total of 122 infertile women were divided into two groups： group A, 〈35 years（n=71）; group B, ≥35 years（n=51）. AMH and FSH were determined on 2-5 d of the early menstrual cycle. AFC was tested on the second day of the menstrual cycle before the start of stimulation.Results Group B had higher FSH levels compared with group A（8.2±3.5 IU/L vs 6.8±2.4 IU/L, P〈0.05）. However, levels of AMH and AFC in group B were lower than those of group A（AMH： 4.2±3.5 μg/L vs 2.7±2.7 μg/L; AFC： 9.0±3.9 vs 5.4±3.3, P〈0.05）. The number of oocyte retrieved in the two groups was not significantly different（11.5±6.8 vs 9.6±6.9, P〉0.05）. The level of AMH was more strongly correlated with the number of oocytes retrieved than that of AFC or FSH level. The strengths of the correlation degrees were AMH level, AFC, and FSH level in turn（r=0.600, 0.511,-0.369）.Conclusion AMH would be a useful predictor for ovarian response.

不同AMH水平的PCOS患者卵巢反应性及与体外受精-胚胎移植结局的关系

目的探究不同抗苗勒管激素(AMH)水平的多囊卵巢综合征(PCOS)患者卵巢反应性与体外受精-胚胎移植结局的关系。方法选取88例PCOS患者,均接受体外受精-胚胎移植,均在取卵促排前进行AMH检测,结合AMH检测结果分为高AMH组(34例)与低中AMH组(54例)。两组患者均进行常规生化检查、卵巢反应性评估、体外受精-胚胎移植结局等相关指标统计,并比较妊娠结局。结果高AMH组和低中AMH组在窦卵泡计数、睾酮、基础垂体生成素、促性腺激素(Gn)用量、优胚率比较,差异有统计学意义(P<0.05),两组患者的基础雌二醇、基础卵泡刺激素、Gn天数、扳机日雌二醇、获卵数、优质卵泡数、受精率、临床妊娠率比较,差异无统计学意义(P>0.05)。结论高AMH水平会影响PCOS患者的卵巢反应性,并对体外受精-胚胎移植结局造成一定影响。

针刺治疗卵巢储备功能减退不孕症临床研究

目的:观察针刺治疗卵巢储备功能减退(DOR)不孕症的疗效及其对促排卵周期胚胎情况的影响。方法:将120例运用体外受精(IVF)或卵胞浆内单精子显微注射(ICSI)助孕治疗的DOR不孕症患者分为对照组和针刺组,每组各60例。对照组接受常规促排卵(COH)周期治疗;针刺组在接受常规促排卵周期治疗前接受针刺治疗,每周3次,治疗12周。比较2组治疗前后血清卵泡刺激素(FSH)、抗缪勒管激素(AMH)水平、双侧卵巢窦卵泡计数(AFC)、双侧卵巢体积、焦虑自评量表(SAS)评分和改良Kupperman评分量表评分,并比较2组治疗后胚胎情况(包括获卵数、正常受精数、可利用胚胎数),同时进行针刺的安全性评价。结果:与治疗前比较,针刺组治疗后FSH水平明显下降,AMH水平升高,差异均有统计学意义(P<0.05)。与治疗前比较,对照组卵巢体积增加,差异有统计学意义(P<0.05)。与对照组治疗后比较,针刺组AFC数量上升,SAS评分降低,可利用胚胎数增多,差异均有统计学意义(P<0.05)。在针刺治疗过程中,无严重不良反应发生。结论:针刺能够降低卵巢储备功能减退不孕症患者血清FSH水平,增加AFC数量,升高AMH水平,改善焦虑症状,改善卵巢功能,增加患者在促排卵周期中的可利用胚胎数,且安全性好。

针灸调周法治疗肾虚血瘀型卵巢储备功能下降的临床观察

【目的】观察针灸调周法治疗肾虚血瘀型卵巢储备功能下降(DOR)的临床疗效。【方法】将120例肾虚血瘀型DOR患者随机分为对照组和治疗组,每组60例。对照组采用西药人工周期法治疗,从月经第5天起首先给予服用戊酸雌二醇片1 mg,每天1次,连续服用21 d,在服用戊酸雌二醇片的第11天给予加服黄体酮胶囊0.2 g,每天2次,连续服用10 d,连服3个月经周期;治疗组采用针灸调周法治疗,取穴:百会、关元、归来、中极、子宫穴、血海、三阴交、太溪、膈俞、肾俞、次髎,隔日1次,每周治疗3次,1个月经周期治疗12次,共治疗3个月经周期。观察2组患者治疗前后中医证候积分、基础性激素[卵泡刺激素(FSH)、黄体生成素(LH)、FSH/LH、雌二醇(E2)、抗缪勒管激素(AMH)]水平及窦卵泡数(AFC)的变化情况,并评价2组患者的中医证候疗效。【结果】(1)治疗3个月经周期后,治疗组的总有效率为93.33%(56/60),对照组为78.33%(47/60),组间比较,治疗组的中医证候疗效明显优于对照组(P<0.05)。(2)治疗后,2组患者的中医证候积分均较治疗前明显降低(P<0.01),且治疗组对中医证候积分的降低作用明显优于对照组(P<0.05)。(3)治疗后,2组患者的血清FSH、LH、FSH/LH水平均较治疗前降低(P<0.01),血清E2水平均较治疗前升高(P<0.01),且治疗组对血清FSH、LH、FSH/LH水平的降低作用及对血清E2水平的升高作用均明显优于对照组(P<0.05或P<0.01)。(4)治疗后,2组患者的血清AMH水平和AFC值均较治疗前升高(P<0.01),且治疗组对血清AMH水平和AFC值的升高作用均明显优于对照组(P<0.05或P<0.01)。【结论】针灸调周法治疗肾虚血瘀型DOR患者疗效确切,能有效改善患者的临床症状和卵巢储备功能,基于月经周期的针灸调周理念可为临床治疗DOR提供新的思路。

腹腔镜剥除术超声刀止血与双极电凝止血对卵巢囊肿患者血清抗米勒管激素、性激素、窦卵泡数及卵巢体积的影响

目的探讨腹腔镜剥除术超声刀止血与双极电凝止血对卵巢囊肿患者血清抗米勒管激素(AMH)、性激素、窦卵泡数及卵巢体积的影响。方法选取2020年1月至2022年1月期间上海市松江区妇幼保健院收治的80例进行腹腔镜剥除术治疗的卵巢囊肿患者作为研究对象,根据手术止血方式的不同将患者分为A组(n=42,超声刀止血)和B组(n=38,双极电凝止血)。记录并比较两组手术相关参数,比较两组手术前后血清AMH、卵泡刺激素(FSH)、雌二醇(E2)、黄体生成素(LH)水平及窦卵泡数、卵巢体积和子宫内膜厚度。结果两组手术时间、术中出血量及下床活动时间和住院时间均未见显著差异(P>0.05)。手术前两组AMH、FSH、E2、LH无显著差异(P>0.05);手术后FSH、LH水平较手术前显著升高,且A组低于B组(P<0.01);AMH、E2水平较手术前下降,A组显著高于B组(P<0.05)。手术前两组窦卵泡数、卵巢体积、子宫内膜厚度无显著差异(P>0.05);手术后窦卵泡数、卵巢体积较手术前均有减少,术后两组子宫内膜厚度均变薄,A组的窦卵泡数显著多于B组(P<0.05),子宫内膜厚度显著大于B组(P<0.05),两组卵巢体积差异不显著(P>0.05)。结论腹腔镜卵巢囊肿剥除术采用超声刀和双极电凝两种止血方式操作简单,能够节省手术时间,术后恢复快,与双极电凝止血相比,术中使用超声刀止血对卵巢组织的损伤较小,对卵巢储备功能的影响较小。

经阴道超声检查联合AMH、雌激素对卵巢储备功能的评估价值

目的 分析经阴道超声检查联合抗苗勒氏管激素(AMH)、雌激素对卵巢储备功能的评估价值。方法 选择我院2019年8月至2021年7月收治的85例不孕症患者为研究对象,根据卵巢储备功能即获卵数量进行分组(获卵数量以5个为界限),分为优组(57例,获卵数≥5个)、差组(28例,获卵数≤4个),选择同期检查健康者为对照组(50例)。于月经第3~5天清晨抽取所有受检者的空腹静脉血进行雌激素[基础促卵泡刺激素(bFSH)、基础促卵泡刺激素/黄体生成素(bFSH/LH)、雌二醇(E2)]、AMH水平检测;采用经阴道彩色多普勒超声技术测定窦卵泡计数(AFC)、卵巢间质动脉收缩期峰值流速(PSV)及卵巢体积(OV)。比较三组研究对象的bFSH、bFSH/LH、E2、AMH水平;比较三组研究对象的AFC、PSV、OV;以临床确诊结果为金标准,比较AMH、雌激素、阴道超声、AMH+雌激素、阴道超声+AMH+雌激素对患者卵巢储备功能差的诊断效能。结果 差组的bFSH、bFSH/LH水平高于优组,E2、AMH水平低于优组,差异具有统计学意义(P<0.05);差组、优组的bFSH、bFSH/LH水平高于对照组,E2、AMH水平低于对照组,差异具有统计学意义(P<0.05)。差组的AFC少于优组,PSV、OV小于优组,差异具有统计学意义(P<0.05);差组、优组的AFC少于对照组,PSV、OV小于对照组,差异具有统计学意义(P<0.05)。阴道超声+AMH+雌激素对卵巢储备功能差的诊断灵敏度、特异度、准确度均较高。结论 在需要进行卵巢储备功能检查的患者中,选择经阴道超声检查联合AMH、雌激素方式具有较高的诊断价值,可以为临床患者的检查、治疗效果评价提供参考依据。

不同AFC分层下应用PPOS和拮抗剂方案的每周期累积活产率比较:一项倾向性评分匹配研究

目的比较拮抗剂方案和高孕激素状态下促排卵(PPOS)方案在不同基础窦卵泡数(AFC)患者中的每取卵周期累积活产率。方法回顾性队列研究分析2017年1月至2021年4月在上海市第一妇婴保健院生殖医学科行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)并采用拮抗剂方案或PPOS方案的3752名不孕症患者临床资料,根据促排卵方案不同分为两组:拮抗剂组和PPOS组,使用倾向性得分匹配(PSM)方法在不同AFC水平(AFC≤5;6≤AFC≤15;AFC≥16)下按1∶1匹配均衡两组间的变量,比较在不同卵巢储备状态(AFC水平不同)下两组患者的基本特征、临床/实验室指标及妊娠结局等;通过多因素Logistic回归分析校正混杂因素后对比两种促排卵治疗的每取卵周期累积活产率。结果匹配后,共1378名(PPOS方案组与拮抗剂方案组各698名)患者纳入分析,两组患者的年龄、不孕因素等基本情况均无显著差异(P>0.05)。在AFC≥16时,拮抗剂方案组的每移植周期临床妊娠率显著高于PPOS组(27.47%vs.16.28%,P<0.05);两组方案在不同AFC水平中的每移植周期种植率、流产率、活产率及累积HCG阳性率、临床妊娠率、持续妊娠率和活产率等妊娠结局均无统计学差异(P均>0.05)。多因素Logistics回归分析校正混杂因素后显示两组促排卵方案的累积活产率无统计学差异(P>0.05),而年龄、取卵次数、基础FSH水平和可利用胚胎数是累积活产率的独立影响因素(P<0.05)。结论在卵巢储备功能相同的情况下,拮抗剂方案和PPOS方案的每取卵周期有着相似的累积活产率;年龄仍是影响IVF/ICSI妊娠结局的主要因素。

地诺孕素药物治疗卵巢子宫内膜异位症对囊肿直径、相关疼痛和卵巢储备的影响

目的 评估地诺孕素药物治疗卵巢子宫内膜异位症对囊肿直径、相关疼痛和卵巢储备的影响,如用窦卵泡计数(AFC)和抗苗勒管激素(AMH)测量。方法 选取32例患者均接受了6个月的地诺孕素药物治疗。在治疗前和治疗6个月结束时比较患者囊肿直径、受影响卵巢的AFC个数、不受影响卵巢的AFC个数、AMH以及VAS评分。结果 治疗前的囊肿直径(4.05±0.75)cm、受影响卵巢的AFC(4.16±1.66)个,VAS评分(6.80±0.85)分,相比较于治疗6个月结束后的囊肿直径(2.66±0.71)cm、受影响卵巢的AFC(8.32±2.33)个,VAS评分(0.87±0.54)分,治疗6个月后囊肿直径明显减小,受影响卵巢的AFC个数明显增多,VAS评分明显降低,差异有统计学意义(P<0.05)。地诺孕素的药物治疗显著降低了子宫内膜异位症的直径和相关的疼痛,AFC显著改善,AMH没有显著变化。结论 地诺孕素药物治疗卵巢子宫内膜异位症对囊肿直径、相关疼痛和卵巢储备有积极的影响,并且具有良好的耐受性。

基础窦状卵泡数结合年龄用于评估卵巢储备及预测卵巢低反应和体外受精临床结局

目的选取基础窦状卵泡数(AFC)≤10个、年龄≥38岁初步作为界定卵巢储备减退的标准,研究在体外受精-胚胎移植(IVF-ET)治疗中通过AFC结合年龄评估卵巢储备、预测卵巢反应以及临床结局的价值。方法回顾性队列研究2003年1月～2008年12月于我院行IVF-ET治疗的AFC≤10个的患者共1319周期。根据AFC数目进行分组,A组:AFC<5个,B组AFC为5～7个,C组AFC为8～10个,同时按患者年龄分为<38岁组和≥38岁组,比较各组患者的基本临床特征、获卵数及临床结局等的差异。结果从A组至C组Gn使用量逐渐增大、可抽吸卵泡数和获卵数逐渐减少,其差异有显著性(P<0.001)。年龄<38岁组Gn使用量显著大于≥38岁组,抽吸卵泡数和获卵数显著高于≥38岁组(P<0.05)。AFC≤7个且年龄<38岁组卵泡数、获卵数少于AFC>7个且年龄≥38岁组,Gn总量前者大于后者,临床妊娠率、分娩率前者高于后者。运用双变量相关分析以及多元线性回归分析获卵数与年龄及基础AFC、基础FSH的关系,得出AFC为卵巢反应性最佳单项预测指标。不同AFC组间患者临床妊娠率有显著性差异,早期自然流产率≥38岁组要明显高于年龄<38岁组。结论任何年龄妇女AFC≤7个或年龄≥38岁则AFC≤10个是卵巢储备降低较为合适的界定指标,若年龄>40岁则AFC≤10个,出现卵巢低反应的几率高,AFC结合年龄是评估卵巢储备、预测卵巢反应性的最佳指标。年龄对于临床妊娠的预测价值,优于AFC。AFC主要影响卵子数量,而年龄主要影响卵子数量及质量。

在体外受精-胚胎移植中应用多项卵巢储备功能评估指标预测卵巢反应性

目的分析卵巢储备功能评估指标与卵巢反应性的关系及对卵巢反应性的预测效能。方法队列研究分析行体外受精(IVF)/单精子卵母细胞内注射(ICSI)的331个取卵周期病例,并将病例分为正常反应组、低反应组以及高反应组3组,采用ELISA方法检测患者月经第3天的血清抗苗勒氏激素(AMH)水平,同时超声测量双侧卵巢内基础窦状卵泡数(AFC),血清基础卵泡刺激素(FSH)、黄体生成素(LH)及雌激素(E2)采用化学免疫发光法检测。结果血清AMH水平、AFC、血清FSH水平、FSH与LH比值(FSH/LH)、年龄均与获卵数×1000/促性腺激素(Gn)总安瓿数相关(P<0.001);而基础E2与其不相关(P>0.05)。AFC及血清AMH水平作为单一指标对于卵巢低反应的预测价值最好,其ROC曲线下面积分别为0.855(0.787-0.924)和0.832(0.764-0.900),对卵巢低反应的最佳预测界值点分别为AFC≤9个,AMH≤1.88 ng/ml。AFC是预测卵巢高反应的最好单一指标,其ROC曲线下面积为0.787(0.728-0.847),最佳预测界值点为AFC≥15个。Logistic逐步回归分析显示联合AFC、血清AMH水平以及血清FSH水平指标能更好地预测卵巢低反应,但联合各指标并不能提高对卵巢高反应的预测效能。结论 AFC、血清AMH水平、血清FSH水平、FSH/LH、年龄均是卵巢反应性的预测指标,但是其敏感性、特异性不同。AFC作为单一指标对于卵巢反应的预测价值最好。联合AFC、血清AMH水平及血清FSH水平能提高对于卵巢低反应的预测效能。而对于卵巢高反应,联合多指标不能提高预测效能。

全子宫与次全子宫切除术治疗子宫肌瘤对女性卵巢功能的影响

目的:对比全子宫与次全子宫切除术治疗子宫肌瘤对女性卵巢功能的影响。方法:选择2011年9月到2015年2月在我院诊治的子宫肌瘤患者146例,根据随机数字表法分为治疗组73例与对照组73例,对照组给予经腹全子宫切除术,治疗组给予经腹次全子宫切除术。结果:治疗组的手术时间、术中出血量、术后肛门排气时间与术后住院时间明显少于对照组(P<0.05)。治疗组术后1个月恶心、呕吐、皮下气肿、下肢静脉血栓、阴道感染等并发症明显少于对照组(P<0.05)。治疗组与对照组术后1个月窦卵泡计数分别为8.89±1.03个和6.19±1.33个,都明显低于术前11.39±2.98个和11.33±2.10个(P<0.05),但两组术后1个月比较差异有统计学意义(P<0.05)。两组术后1个月的血清雌二醇(E2)值明显低于术前(P<0.05),而血清卵泡刺激素(FSH)值明显高于术前(P<0.05),但组间比较差异都无统计学意义(P>0.05)。结论:子宫切除术对卵巢功能均有一定的负面影响,但次全子宫切除术对AFC的影响更小,减少术后并发症的发生,有较好的应用价值。

阴道彩超预测基础FSH水平正常患者超排卵中卵巢反应性的价值

目的探讨经阴道彩色多普勒测量早卵泡期窦卵泡计数(antralfolliclecount,AFC)及卵巢基质血流峰值流速(stromalpeaksystolicvelocity,PSV)、阻力指数(resistanceindex,RI)在预测基础卵泡刺激素(basalfolliclestimulatinghormone,bFSH)水平正常患者促性腺激素释放激素激动剂(GnRH-α)短方案超排卵(controlledovarianhyperstimulation,COH)治疗中卵巢反应性的价值。方法2003年9月￣2004年8月在该院生殖医学中心接受体外受精(in-vitrofertilization,IVF)或单精子胞浆内注射(intracytoplasmicsperminjection,ICSI)助孕治疗的不孕症患者,bFSH水平为该中心行IVF的正常值范围。于月经第2天行阴道彩超检查,测量早卵泡期AFC及PSV、RI,并在当周期行GnRH-α短方案COH治疗,观察获卵数以判断卵巢的反应性。结果45例bFSH水平正常患者接受COH治疗,在匹配了年龄和bFSH水平后观察到反应正常组与反应不良组AFC与PSV差异有显著性,外源性卵泡刺激素用量及刺激时间差异有显著性,而RI差异无显著性。促排卵反应不良病史也是卵巢低反应性的影响因素。结论经阴道彩超测量早卵泡期AFC及PSV是bFSH水平正常患者进行GnRH-α短方案COH前评价卵巢反应性的较好指标。