Guo Jing, Zhang Qingxue, Li Yu, Huang Jia, Wang Wenjun, Huang Lili, Zhao Xiaomiao, Yang Dongzi
Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Reprod Biomed Online. 2014 Jun;28(6):723-32. doi: 10.1016/j.rbmo.2014.02.009. Epub 2014 Mar 4.
No single or multivariate model is effective for predicting poor ovarian response (POR) with satisfactory sensitivity and specificity. This study investigated whether dehydroepiandrosterone sulphate (DHEAS) or basal testosterone concentrations could be effective predictors of POR defined by the Bologna criteria. This retrospective study included 79 poor responders and 128 normal responders. Serum FSH, LH, oestradiol, DHEAS and testosterone concentrations on day 3 of the menstrual cycle before the treatment cycle were measured. All patients received standard ovarian stimulation with FSH under pituitary suppression with gonadotrophin-releasing hormone agonist. DHEAS concentration was not significantly different between poor and normal responders or between pregnant and nonpregnant women. Basal testosterone, unlike DHEAS concentration, was predictive, but with limited ability as a single predictor, for POR. The multivariate model composed of age, AFC, FSH, FSH/LH and testosterone was reliably predictive for POR (ROC(AUC) = 0.976, cut-off point >0.51, sensitivity 88.6%, specificity 98.3%) and clinical pregnancy (ROC(AUC) = 0.716, cut-off point ⩽-0.22, sensitivity 75%, specificity 62.5%) and was better than antral follicle count for predicting both POR and clinical pregnancy. This multivariate model might be useful for identifying patients at risk of poor response in order to optimize the stimulation regimens. No single or multivariate model is effective for predicting poor ovarian response (POR) with satisfactory sensitivity and specificity. It has been suggested that androgens stimulate folliculogenesis and their concentrations might be correlated with oocyte yield after ovulation induction. We investigated whether dehydroepiandrosterone sulphate (DHEAS) or basal testosterone concentrations could be effective predictors for POR defined by the Bologna criteria. This is a retrospective study with 79 poor responders and 128 normal responders. Serum FSH, LH, oestradiol, DHEAS and testosterone on day 3 of the menstrual cycle before the treatment cycle were measured. All patients received standard ovarian stimulation with FSH under pituitary suppression with gonadotrophin-releasing hormone agonist. DHEAS concentration was not significantly different between poor and normal responders or between pregnant and nonpregnant women. Basal testosterone, instead of DHEAS, was predictive, but with limited ability as a single predictor, for POR. However, the multivariate model of (0.563 × Z(age)) − (0.505 × Z(AFC)) + (0.506 × Z(FSH)) + (0.34 × Z(FSH/LH)) − (0.24 × Z(testosterone)) (Z(Xi) = standardized values of variables) was reliably predictive for POR (ROC(AUC) = 0.976) and pregnancy (ROC(AUC) = 0.716) and was better than antral follicle count for predicting both POR and pregnancy. This multivariate model composed of age, AFC, FSH, FSH/LH and testosterone might be useful for identifying patients at risk of poor response in order to optimize the stimulation regimens.
没有单一模型或多变量模型能够以令人满意的敏感性和特异性有效预测卵巢低反应（POR）。本研究调查硫酸脱氢表雄酮（DHEAS）或基础睾酮浓度是否可作为根据博洛尼亚标准定义的POR的有效预测指标。这项回顾性研究纳入了79例低反应者和128例正常反应者。测量了治疗周期前月经周期第3天的血清促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇、DHEAS和睾酮浓度。所有患者在使用促性腺激素释放激素激动剂抑制垂体的情况下接受FSH标准卵巢刺激。低反应者与正常反应者之间或妊娠与未妊娠女性之间的DHEAS浓度无显著差异。与DHEAS浓度不同，基础睾酮可作为POR的预测指标，但作为单一预测指标的能力有限。由年龄、窦卵泡计数（AFC）、FSH、FSH/LH和睾酮组成的多变量模型对POR（ROC（AUC）=0.976，截断点>0.51，敏感性88.6%，特异性98.3%）和临床妊娠（ROC（AUC）=0.716，截断点≤ -0.22，敏感性75%，特异性62.5%）具有可靠的预测性，并且在预测POR和临床妊娠方面优于窦卵泡计数。该多变量模型可能有助于识别低反应风险患者，以优化刺激方案。没有单一模型或多变量模型能够以令人满意的敏感性和特异性有效预测卵巢低反应（POR）。有人提出雄激素刺激卵泡生成，其浓度可能与排卵诱导后的卵母细胞产量相关。我们调查了硫酸脱氢表雄酮（DHEAS）或基础睾酮浓度是否可作为根据博洛尼亚标准定义的POR的有效预测指标。这是一项回顾性研究，有79例低反应者和128例正常反应者。测量了治疗周期前月经周期第3天的血清FSH、LH、雌二醇、DHEAS和睾酮。所有患者在使用促性腺激素释放激素激动剂抑制垂体的情况下接受FSH标准卵巢刺激。低反应者与正常反应者之间或妊娠与未妊娠女性之间的DHEAS浓度无显著差异。基础睾酮而非DHEAS可作为POR的预测指标，但作为单一预测指标的能力有限。然而，（0.563×Z（年龄））−（0.505×Z（AFC））+（0.506×Z（FSH））+（0.34×Z（FSH/LH））−（0.24×Z（睾酮））（Z（Xi）=变量的标准化值）的多变量模型对POR（ROC（AUC）=0.976）和妊娠（ROC（AUC）=0.716）具有可靠的预测性，并且在预测POR和妊娠方面优于窦卵泡计数。由年龄、AFC、FSH、FSH/LH和睾酮组成的该多变量模型可能有助于识别低反应风险患者，以优化刺激方案。
