一种新的卵巢反应预测指数（ORPI）：对个体化控制性卵巢刺激的意义。
A new ovarian response prediction index (ORPI): implications for individualised controlled ovarian stimulation.
机构信息
Centre for Human Reproduction Prof, Franco Junior, Preto, Ribeirao, Brazil.
出版信息
Reprod Biol Endocrinol. 2012 Nov 21;10:94. doi: 10.1186/1477-7827-10-94.
BACKGROUND
The objective was to present a new ovarian response prediction index (ORPI), which was based on anti-Müllerian hormone (AMH) levels, antral follicle count (AFC) and age, and to verify whether it could be a reliable predictor of the ovarian stimulation response.
METHODS
A total of 101 patients enrolled in the ICSI programme were included. The ORPI values were calculated by multiplying the AMH level (ng/ml) by the number of antral follicles (2-9 mm), and the result was divided by the age (years) of the patient (ORPI=(AMH x AFC)/Patient age).
RESULTS
The regression analysis demonstrated significant (P<0.0001) positive correlations between the ORPI and the total number of oocytes and of MII oocytes collected. The logistic regression revealed that the ORPI values were significantly associated with the likelihood of pregnancy (odds ratio (OR): 1.86; P=0.006) and collecting greater than or equal to 4 oocytes (OR: 49.25; P<0.0001), greater than or equal to 4 MII oocytes (OR: 6.26; P<0.0001) and greater than or equal to 15 oocytes (OR: 6.10; P<0.0001). Regarding the probability of collecting greater than or equal to 4 oocytes according to the ORPI value, the ROC curve showed an area under the curve (AUC) of 0.91 and an efficacy of 88% at a cut-off of 0.2. In relation to the probability of collecting greater than or equal to 4 MII oocytes according to the ORPI value, the ROC curve had an AUC of 0.84 and an efficacy of 81% at a cut-off of 0.3. The ROC curve for the probability of collecting greater than or equal to 15 oocytes resulted in an AUC of 0.89 and an efficacy of 82% at a cut-off of 0.9. Finally, regarding the probability of pregnancy occurrence according to the ORPI value, the ROC curve showed an AUC of 0.74 and an efficacy of 62% at a cut-off of 0.3.
CONCLUSIONS
The ORPI exhibited an excellent ability to predict a low ovarian response and a good ability to predict a collection of greater than or equal to 4 MII oocytes, an excessive ovarian response and the occurrence of pregnancy in infertile women. The ORPI might be used to improve the cost-benefit ratio of ovarian stimulation regimens by guiding the selection of medications and by modulating the doses and regimens according to the actual needs of the patients.
背景
本研究旨在提出一种新的卵巢反应预测指数（ORPI），该指数基于抗苗勒管激素（AMH）水平、窦卵泡计数（AFC）和年龄，并验证其是否能可靠地预测卵巢刺激反应。
方法
共纳入 101 例接受 ICSI 治疗的患者。ORPI 值通过将 AMH 水平（ng/ml）乘以窦卵泡数（2-9mm），再除以患者年龄（年）来计算（ORPI=（AMH x AFC）/患者年龄）。
结果
回归分析显示，ORPI 与获卵总数和成熟卵母细胞（MII 卵）数之间存在显著（P<0.0001）正相关。逻辑回归显示，ORPI 值与妊娠可能性（优势比（OR）：1.86；P=0.006）和获得≥4 个卵母细胞（OR：49.25；P<0.0001）、≥4 个 MII 卵母细胞（OR：6.26；P<0.0001）和≥15 个卵母细胞（OR：6.10；P<0.0001）显著相关。根据 ORPI 值预测获得≥4 个卵母细胞的概率，ROC 曲线的曲线下面积（AUC）为 0.91，截点为 0.2 时的效能为 88%。根据 ORPI 值预测获得≥4 个 MII 卵母细胞的概率，ROC 曲线的 AUC 为 0.84，截点为 0.3 时的效能为 81%。根据 ORPI 值预测获得≥15 个卵母细胞的概率，ROC 曲线的 AUC 为 0.89，截点为 0.9 时的效能为 82%。最后，根据 ORPI 值预测妊娠发生的概率，ROC 曲线的 AUC 为 0.74，截点为 0.3 时的效能为 62%。
结论
ORPI 对低卵巢反应有很好的预测能力，对获得≥4 个 MII 卵母细胞、过度卵巢反应和不孕患者妊娠的预测能力也较好。ORPI 可能通过指导药物选择，根据患者的实际需要调整剂量和方案，提高卵巢刺激方案的成本效益比。
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