Abuelghar Wessam M, Bayoumy Hassan A, Ellaithy Mohamed I, Khalil Marian S
Obstetrics and Gynecology Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt.
Obstetrics and Gynecology Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt.
Eur J Obstet Gynecol Reprod Biol. 2014 Apr;175:178-85. doi: 10.1016/j.ejogrb.2014.01.016. Epub 2014 Jan 20.
To evaluate the role of different clinical, biochemical and sonographic factors as predictors of spontaneous ovulation after laparoscopic ovarian drilling (LOD) in women with clomiphene citrate resistant polycystic ovarian disease (CCR-PCOD).
This prospective study recruited 251 infertile women with CCR-PCOD. Several clinical, biochemical and sonographic criteria were tested as possible predictors of spontaneous ovulation after LOD using multivariate analysis.
Women with higher preoperative levels of LH, FSH and/or androstenedione had significantly higher rates of spontaneous ovulation within the first eight weeks after LOD, but only FSH and androstenedione were found to be independent predictors. Other factors including age, BMI, type of infertility, duration of infertility, menstrual pattern, testosterone level, ovarian volume and SHBG were insignificant predictors. Receiver-operating characteristic (ROC) curves derived from FSH, LH, androstenedione, and a logistic regression model showed that the best cut-off values were 4.1IU/l, 7.8IU/l, 1.2ng/ml, and 0.4897, respectively, with sensitivity of 91.18%, 100%, 73.53%, and 88.24% and specificity of 69.57%, 69.57%, 65.22%, and 73.91% for FSH, LH, androstenedione, and logistic regression model respectively. An extended follow up (9 months after LOD) was conducted for the anovulatory and the non-pregnant ovulatory women, who were treated individually according to their clinical situation. Of these women, 53.5% (69/129) got pregnant, resulting in a cumulative pregnancy rate of 48% (82/171). Of these pregnancies, 16/82 (19.5%) were spontaneous while 35.4% (29/82) and 45.1% (37/82) occurred after ovulation induction by CC and gonadotropins, respectively.
This study supports the use of androstenedione, LH and FSH as a simple reliable tool in triaging patients with CCR-PCOD to select the ideal candidates for LOD.
评估不同临床、生化及超声因素对枸橼酸氯米芬抵抗性多囊卵巢疾病（CCR-PCOD）女性腹腔镜卵巢打孔术（LOD）后自发排卵的预测作用。
这项前瞻性研究纳入了251例CCR-PCOD不孕女性。使用多因素分析测试了几种临床、生化及超声标准作为LOD后自发排卵的可能预测因素。
术前LH、FSH和/或雄烯二酮水平较高的女性在LOD后的前八周内自发排卵率显著更高，但仅发现FSH和雄烯二酮是独立预测因素。其他因素包括年龄、BMI、不孕类型、不孕持续时间、月经模式、睾酮水平、卵巢体积和SHBG均为无显著意义的预测因素。由FSH、LH、雄烯二酮及逻辑回归模型得出的受试者工作特征（ROC）曲线显示，最佳截断值分别为4.1IU/l、7.8IU/l、1.2ng/ml和0.4897，FSH、LH、雄烯二酮及逻辑回归模型的敏感性分别为91.18%、100%、73.53%和88.24%，特异性分别为69.57%、69.57%、65.22%和73.91%。对无排卵和排卵但未孕的女性进行了延长随访（LOD后9个月），并根据其临床情况进行个体化治疗。在这些女性中，53.5%（69/129）怀孕，累积妊娠率为48%（82/171）。在这些妊娠中，16/82（19.5%）为自然妊娠，35.4%（29/82）和45.1%（37/82）分别在克罗米芬（CC）和促性腺激素诱导排卵后发生。
本研究支持将雄烯二酮、LH和FSH作为一种简单可靠的工具，用于对CCR-PCOD患者进行分类，以选择LOD的理想候选者。
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