Jaiswar S P, Natu S M, Sankhwar P L, Manjari Gupta
Department of Obstetrics and Gynaecology, KGMU, Lucknow, India.
Department of Pathology, KGMU, Lucknow, India.
J Obstet Gynaecol India. 2015 Dec;65(6):411-6. doi: 10.1007/s13224-014-0639-8. Epub 2014 Dec 25.
To study correlation between ovarian reserve with biophysical markers (antral follicle count and ovarian volume) and biochemical markers (S. FSH, S. Inhibin B, and S. AMH) and use these markers to predict poor ovarian response to ovarian induction.
This is a prospective observational study. One hundred infertile women attending the Obst & Gynae Dept, KGMU were recruited. Blood samples were collected on day 2/day 3 for assessment of S. FSH, S. Inhibin B, and S. AMH and TVS were done for antral follicle count and ovarian volume. Clomephene citrate 100 mg 1OD was given from day 2 to 6, and patients were followed up with serial USG measurements. The numbers of dominant follicles (> or = 14 mm) at the time of hCG administration were counted. Patients with <3 follicles in the 1st cycle were subjected to the 2nd cycle of clomephene 100 mg 1OD from day 2 to day 6 with Inj HMG 150 IU given i.m. starting from day 8 and every alternate day until at least one leading follicle attained ≥18 mm. Development of <3 follicles at end of the 2nd cycle was considered as poor response.
Univariate analyses showed that s. inhibin B presented the highest (ROCAUC = 0.862) discriminating potential for predicting poor ovarian response, In multivariate logistic regression model, the variables age, FSH, AMH, INHIBIN B, and AFC remained significant, and the resulting model showed a predicted accuracy of 84.4 %.
A derived multimarker computation by a logistic regression model for predicting poor ovarian response was obtained through this study. Thus, potential poor responders could be identified easily, and appropriate ovarian stimulation protocol could be devised for such pts.
研究卵巢储备与生物物理标志物（窦卵泡计数和卵巢体积）及生化标志物（血清促卵泡生成素、血清抑制素B和血清抗苗勒管激素）之间的相关性，并利用这些标志物预测卵巢刺激反应不良。
这是一项前瞻性观察性研究。招募了100名到甘地医学院妇产科就诊的不孕女性。在第2天/第3天采集血样以评估血清促卵泡生成素、血清抑制素B和血清抗苗勒管激素，并进行经阴道超声检查以测定窦卵泡计数和卵巢体积。从第2天至第6天给予枸橼酸氯米芬100mg每日一次，并通过连续超声检查对患者进行随访。计算注射人绒毛膜促性腺激素时优势卵泡（≥14mm）的数量。第1周期卵泡数<3个的患者，从第2天至第6天接受第2周期的枸橼酸氯米芬100mg每日一次治疗，并从第8天开始肌肉注射重组人促卵泡激素150IU，每隔一天注射一次，直至至少有一个优势卵泡达到≥18mm。第2周期结束时卵泡数<3个被视为反应不良。
单因素分析显示，血清抑制素B对预测卵巢反应不良具有最高的判别潜力（受试者工作特征曲线下面积=0.862）。在多因素逻辑回归模型中，年龄、促卵泡生成素、抗苗勒管激素、抑制素B和窦卵泡计数等变量仍然显著，所得模型显示预测准确率为84.4%。
通过本研究获得了一种由逻辑回归模型推导的多标志物计算方法，用于预测卵巢反应不良。因此，可以轻松识别潜在的反应不良者，并为这些患者制定合适的卵巢刺激方案。
