Spressão Meire, Oliani Antonio Hélio, Oliani Denise Cristina Mós Vaz
Gynecology and Obstetrics Department, Faculdade de Medicina de São José do Rio Preto, Instituto de Medicina Reprodutiva e Fetal, São José do Rio Preto, SP, Brazil.
Rev Bras Ginecol Obstet. 2016 Oct;38(10):499-505. doi: 10.1055/s-0036-1593969. Epub 2016 Nov 28.
To identify which methods used in the assessment of the ovarian reserve are exclusive or complementary to identify the best response to follicle development. Retrospective cohort study, involving patients undergoing assisted reproduction treatment at the Instituto de Medicina Reprodutiva e Fetal, from April 2009 to July 2014. Age, biochemical tests, and ultrasound were assessed. The data were analyzed to predict the follicular development and the relation between them, using, for statistical analysis, Statistical Package for Social Sciences software. Out of the 293 couples included, 50.2% presented infertility by ovarian factor. Considering the age as the main variable, a significant negative correlation with the volume of both ovaries was observed (right ovary, r = 0.21; left ovary, r = -0.22; both < 0.0001), and with the antral follicle count (right ovary, r = -0.38; left ovary, r = -0.47; both < 0.0001). Considering the antral follicle count as the main variable, a significant positive correlation with the total recruited oocytes was observed. When we correlated the antral follicle count with the recruited follicles larger than 18 mm, we observed that, with a cutoff of 12 antral follicles, there is a positive predictive value of 99%, and an area under the ROC curve of 0.76. We concluded from our study that age and antral follicle count are effective predictors of ovarian response in cycles of assisted reproduction. The ovarian volume, as well as the anti-Müllerian hormone dosage, seem to be adequate markers of the ovarian reserve.
为了确定在评估卵巢储备时所使用的哪些方法是相互独立的或互补的，以识别对卵泡发育的最佳反应。回顾性队列研究，纳入2009年4月至2014年7月在生殖医学与胎儿医学研究所接受辅助生殖治疗的患者。评估年龄、生化检查和超声检查结果。使用社会科学统计软件对数据进行分析，以预测卵泡发育情况及其相互关系。在纳入的293对夫妇中，50.2%因卵巢因素导致不孕。将年龄作为主要变量时，观察到其与双侧卵巢体积呈显著负相关（右卵巢，r = 0.21；左卵巢，r = -0.22；均P < 0.0001），与窦卵泡计数也呈显著负相关（右卵巢，r = -0.38；左卵巢，r = -0.47；均P < 0.0001）。将窦卵泡计数作为主要变量时，观察到其与募集的卵母细胞总数呈显著正相关。当我们将窦卵泡计数与募集的直径大于18 mm的卵泡进行关联分析时，发现以12个窦卵泡为临界值，其阳性预测值为99%，ROC曲线下面积为0.76。我们从研究中得出结论，年龄和窦卵泡计数是辅助生殖周期中卵巢反应的有效预测指标。卵巢体积以及抗苗勒管激素剂量似乎是卵巢储备的合适标志物。
