Padhy Nabaneeta, Gupta Shalu, Mahla Asmita, Latha M, Varma Thangam
Institute of Reproductive Medicine, Madras Medical Mission, Chennai - 600 037, India.
J Hum Reprod Sci. 2010 May;3(2):91-4. doi: 10.4103/0974-1208.69343.
Ovarian response varies considerably among individuals and depends on various factors. Poor response in IVF yields lesser oocytes and is associated with poorer pregnancy perspective. Cycle cancellation due to poor response is frustrating for both clinician and the patient. Studies have shown that women conceiving after poor ovarian response have more pregnancy complications like PIH and preeclampsia than women with normal ovarian response. In addition, poor ovarian response could be a predictor of early menopause. This paper studies various demographic and clinical profiles of poor responders and tries to look at the known and unknown factors which could contribute to poor ovarian response in IVF.
Data were collected retrospectively from 104 poor responders who had less than four oocytes at retrieval and compared with 324 good responders for factors like age, BMI, type of sub fertility, duration of sub fertility, environmental factors like stress at work, smoking, pelvic surgery, chronic medical disorder, indication of IVF, basal FSH, mean age of menopause in their mothers etc.
Among the poor responders, 60.57% were above 35 years of age compared to 36.41% in control group, which is statistically significant. Mean age of menopause in mother was found to be four years earlier in poor responder group. Male factor and unexplained infertility were significantly (P<0.05) higher in good responders (P<0.05). Significant proportion (31.73%) of women in study group had undergone some pelvic surgery (P<0.05).
Apart from age, prior pelvic surgery also could be used as predictors for poor ovarian response. Heredity also plays a major role in determining ovarian response.
个体间的卵巢反应差异很大，且取决于多种因素。体外受精（IVF）中反应不佳会导致获得的卵母细胞较少，并与较差的妊娠前景相关。因反应不佳而取消周期对临床医生和患者来说都令人沮丧。研究表明，卵巢反应不佳后受孕的女性比卵巢反应正常的女性有更多的妊娠并发症，如妊娠期高血压疾病（PIH）和先兆子痫。此外，卵巢反应不佳可能是早期绝经的一个预测指标。本文研究了反应不佳者的各种人口统计学和临床特征，并试图探讨可能导致IVF中卵巢反应不佳的已知和未知因素。
回顾性收集了104例取卵时获得少于4个卵母细胞的反应不佳者的数据，并与324例反应良好者比较年龄、体重指数（BMI）、亚生育类型、亚生育持续时间、工作压力等环境因素、吸烟、盆腔手术、慢性疾病、IVF指征、基础卵泡刺激素（FSH）、其母亲绝经的平均年龄等因素。
反应不佳者中，60.57%年龄在35岁以上，而对照组为36.41%，差异有统计学意义。发现反应不佳者组其母亲绝经的平均年龄早4年。反应良好者中男性因素和不明原因不孕显著更高（P<0.05）。研究组中有相当比例（31.73%）的女性接受过某种盆腔手术（P<0.05）。
除年龄外，既往盆腔手术也可作为卵巢反应不佳的预测指标。遗传因素在决定卵巢反应方面也起主要作用。
