Zhen X M, Qiao J, Li R, Wang L N, Liu P
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100083, China.
J Assist Reprod Genet. 2008 Jan;25(1):17-22. doi: 10.1007/s10815-007-9187-9. Epub 2008 Jan 18.
To explore the prevalence, predictor of clinical pregnancy and possible aetiology of poor ovarian response (POR) in in vitro fertilization-embryo transfer (IVF-ET) in Chinese.
A total of 4,600 retrieval oocyte cycles were finished between July 1, 2004 and April 30, 2006. Poor ovarian responses were observed in 426 patients of 472 cycles undergoing IVF, which were selected on the same retrieve oocyte day as the control group. The outcome of IVF-ET and the common markers of ovarian reserve were compared.
The patients had previous ovarian surgery in 64 cycles of 472 poor ovarian response cycles. The group with poor ovarian response has significant differences in comparison with the control group in age (36.6 +/- 4.2 vs 33.3 +/- 4.04), ovarian surgeries (13.6 vs 2.8%), dose of gonadotrophin (58.5 +/- 15.8 vs 40.6 +/- 17.0), fertilization rate (71.5 vs 86%) and pregnancy rate (14.8 vs 36.7%). In the group with poor ovarian responses, clinical pregnancy rate declined significantly in women aged >40 years than in those aged < or = 40 years (2.8 vs 18.5%, P < 0.001). The age, basal serum follicle stimulating hormone (FSH), basal serum luteinizing hormone (LH), basal oestradiol (E2) concentrations, FSH to LH ratio and the antral follicle count (AFC) are the common markers of ovarian reserve in our center. We found that there were significant differences in age, basal FSH, FSH-to-LH ratio and the antral follicle count. But no statistical significant differences were observed in basal oestradiol concentration and basal serum LH when comparing the two groups. Binary logistic regression analysis was used to study the relation among age, FSH, LH, E2, AFC and clinical pregnancy, and the age (odds ratio, 0.863; 95% confidence interval, 0.805-0.925; p = 0.000) was the only variable selected.
Our data show that the prevalence of poor ovarian response in Chinese is 11.9%. Previous ovarian surgery is associated with poor ovarian responses. The pregnancy rate of women with poor ovarian response is low in IVF-ET, especially the decline in clinical pregnancy rate of women aged >40 years became accelerated. Correct identification of those who are at risk for POR prior to stimulation is helpful in tailoring the best stimulation protocol to individual patients. Chronological age significantly improved the prediction of clinical pregnancy of poor ovarian responders.
探讨中国体外受精 - 胚胎移植（IVF - ET）中卵巢反应不良（POR）的发生率、临床妊娠预测因素及可能病因。
2004年7月1日至2006年4月30日共完成4600个取卵周期。在472个接受IVF的周期中，有426例患者出现卵巢反应不良，这些患者与对照组在同一天取卵。比较IVF - ET的结局及卵巢储备的常见指标。
472个卵巢反应不良周期中，64个周期的患者曾接受过卵巢手术。卵巢反应不良组与对照组在年龄（36.6±4.2岁 vs 33.3±4.04岁）、卵巢手术史（13.6% vs 2.8%）、促性腺激素剂量（58.5±15.8 vs 40.6±17.0）、受精率（71.5% vs 86%）和妊娠率（14.8% vs 36.7%）方面存在显著差异。在卵巢反应不良组中，年龄>40岁的女性临床妊娠率显著低于年龄≤40岁的女性（2.8% vs 18.5%，P<0.001）。年龄、基础血清卵泡刺激素（FSH）、基础血清黄体生成素（LH）、基础雌二醇（E2）浓度、FSH/LH比值及窦卵泡计数（AFC）是本中心卵巢储备的常见指标。我们发现年龄、基础FSH、FSH/LH比值及窦卵泡计数存在显著差异。但两组比较时，基础雌二醇浓度和基础血清LH未观察到统计学显著差异。采用二元逻辑回归分析研究年龄、FSH、LH、E2、AFC与临床妊娠之间的关系，年龄（优势比，0.863；95%置信区间，0.805 - 0.925；P = 0.000）是唯一入选变量。
我们的数据显示中国卵巢反应不良的发生率为11.9%。既往卵巢手术与卵巢反应不良有关。IVF - ET中卵巢反应不良女性的妊娠率较低，尤其是年龄>40岁女性的临床妊娠率下降加速。在刺激前正确识别POR风险患者有助于为个体患者制定最佳刺激方案。实际年龄显著提高了对卵巢反应不良患者临床妊娠的预测能力。
