Yun Bo Hyon, Kim Gieun, Park Seon Hee, Noe Eun Bee, Seo Seok Kyo, Cho SiHyun, Choi Young Sik, Lee Byung Seok
Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2017 Jan;60(1):46-52. doi: 10.5468/ogs.2017.60.1.46. Epub 2017 Jan 19.
This study aimed to identify factors that affect in vitro fertilization (IVF) outcomes in women with diminished ovarian reserve (DOR).
We reviewed 99 IVF cycles in 52 women with DOR between September 2010 and January 2015. DOR was defined as serum anti-Müllerian hormone level of <1.1 ng/dL or serum follicle-stimulating hormone level of ≥20 mIU/mL. Total 96 cycles in 50 patients were evaluated after excluding fertility preservation cases.
The clinical pregnancy rate was 11.5% per cycle, and the total cancellation rate was 34.4%. Clinical pregnancy rate was significantly associated with the antral follicle count and the cause of the DOR. Age, serum anti-Müllerian hormone and follicle-stimulating hormone levels, antral follicle count, peak estradiol level, and the cause of DOR were significantly associated with cycle cancellation. However, history of previous ovarian surgery remained as a significant factor of clinical pregnancy (model 1: odds ratio [OR] 10.17, 95% confidence interval [CI] 1.46 to 70.84, =0.019; model 2: OR 10.85, 95% CI 1.05 to 111.71, =0.045). In cancellation models, idiopathic or previous chemotherapy group showed borderline significance (model 1: OR 3.76, 95% CI 0.83 to 17.04, =0.086; model 2: OR 3.15, 95% CI 0.84 to 11.84, =0.09).
DOR caused by previous ovarian surgery may show better pregnancy outcome, whereas that caused by chemotherapy could significantly increase the cycle cancellation rate. Furthermore, patients with DOR who previously received gonadotoxic agents may show reduced efficacy and increased risk of IVF cycle cancellation.
本研究旨在确定影响卵巢储备功能减退（DOR）女性体外受精（IVF）结局的因素。
我们回顾了2010年9月至2015年1月期间52例DOR女性的99个IVF周期。DOR定义为血清抗苗勒管激素水平<1.1 ng/dL或血清促卵泡激素水平≥20 mIU/mL。排除生育力保存病例后，对50例患者的96个周期进行了评估。
临床妊娠率为每个周期11.5%，总取消率为34.4%。临床妊娠率与窦卵泡计数及DOR的病因显著相关。年龄、血清抗苗勒管激素和促卵泡激素水平、窦卵泡计数、雌二醇峰值水平及DOR的病因与周期取消显著相关。然而，既往卵巢手术史仍是临床妊娠的一个重要因素（模型1：比值比[OR] 10.17，95%置信区间[CI] 1.46至70.84，P = 0.019；模型2：OR 10.85，95% CI 1.05至111.71，P = 0.045）。在取消周期模型中，特发性或既往化疗组显示出临界显著性（模型1：OR 3.76，95% CI 0.83至17.04，P = 0.086；模型2：OR 3.15，95% CI 0.84至11.84，P = 0.09）。
既往卵巢手术导致的DOR可能显示出更好的妊娠结局，而化疗导致的DOR可能显著增加周期取消率。此外，既往接受性腺毒性药物治疗的DOR患者可能显示出疗效降低和IVF周期取消风险增加。
