Department of Perinatology, Medical University, Gdańsk, Poland.
Eur J Obstet Gynecol Reprod Biol. 2013 Jun;168(2):173-7. doi: 10.1016/j.ejogrb.2013.01.013. Epub 2013 Feb 26.
To examine common clinical determinants, including patient age; levels of anti-Müllerian hormone (AMH), inhibin B, and follicle-stimulating hormone (FSH); antral follicle count (AFC); and number of oocytes retrieved, to predict live births in women undergoing in vitro fertilization.
Women undergoing cycles of intracytoplasmic sperm injection (ICSI) for the first time were reviewed retrospectively, and serum levels of AMH, inhibin B, and FSH, as well as AFC (days 1 and 4 of pre-ICSI menstrual period) and patient age were analyzed as determinants of live birth rates.
Of the patients studied, 35.71% (891/2495) became pregnant, with live births achieved in 32.20% (806/2495) of cycles initiated and in 46.37% (806/1738) of embryo transfers. Clinical pregnancy rate was 35.71% (891/2495) for cycles initiated and 51.26% (891/2318) for embryo transfers. Univariate analysis revealed that the odds of live birth significantly decreased with increasing age, declining AMH or inhibin B concentrations, and fewer oocytes retrieved. At AMH levels greater than 5.7 ng/ml, the odds of live birth were 3.18 times greater than for AMH levels less than 1.9 ng/ml [95% confidence interval (CI), 1.89-5.43]. Using multivariate logistic regression, only AMH (OR = 1.89; 95% CI, 1.00-3.60; p < 0.05) and AFC (OR = 1.86; 95% CI, 1.02-3.40; p < 0.05) showed statistically significant associations with live birth. Area under the curve for ROC (ROC(AUC)) indicated that AMH (AUC = 0.60) surpassed AFC (AUC = 0.59), number of oocytes retrieved (AUC = 0.59), inhibin B (AUC = 0.55), FSH (ROC(AUC) = 0.54) and chronological age (ROC(AUC) = 0.53) in predicting live birth.
In this assessment of various indices (i.e., age; levels of AMH, inhibin B, and FSH; AFC; and quantity of oocytes retrieved) for predicting live births for IVF patients, AMH, AFC and the quantity of oocytes retrieved constituted the most reliable determinants.
探讨常见的临床决定因素，包括患者年龄、抗苗勒管激素（AMH）、抑制素 B 和卵泡刺激素（FSH）水平、窦卵泡计数（AFC）以及获卵数，以预测行体外受精的女性的活产率。
回顾性分析首次接受胞浆内单精子注射（ICSI）治疗的女性患者，分析 AMH、抑制素 B 和 FSH 水平以及 AFC（ICSI 前月经周期第 1 天和第 4 天）和患者年龄作为活产率的决定因素。
在研究的患者中，35.71%（891/2495）妊娠，起始周期活产率为 32.20%（806/2495），胚胎移植活产率为 46.37%（806/1738）。起始周期的临床妊娠率为 35.71%（891/2495），胚胎移植的临床妊娠率为 51.26%（891/2318）。单因素分析显示，活产率随年龄增长、AMH 或抑制素 B 浓度降低和获卵数减少而显著降低。AMH 水平大于 5.7ng/ml 时，活产的几率是 AMH 水平小于 1.9ng/ml 的 3.18 倍[95%置信区间（CI），1.89-5.43]。采用多变量逻辑回归，仅 AMH（OR=1.89；95%CI，1.00-3.60；p<0.05）和 AFC（OR=1.86；95%CI，1.02-3.40；p<0.05）与活产有统计学显著关联。ROC（ROC(AUC))的曲线下面积表明 AMH（AUC=0.60）优于 AFC（AUC=0.59）、获卵数（AUC=0.59）、抑制素 B（AUC=0.55）、FSH（ROC(AUC)=0.54）和年龄（ROC(AUC)=0.53），可预测活产。
在评估预测 IVF 患者活产率的各种指标（即年龄、AMH、抑制素 B 和 FSH 水平、AFC 和获卵数）中，AMH、AFC 和获卵数是最可靠的决定因素。
