Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
Division of Reproductive Endocrinology and Infertility, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Am J Obstet Gynecol. 2017 Aug;217(2):129-140. doi: 10.1016/j.ajog.2017.02.027. Epub 2017 Feb 21.
Ovarian reserve is a complex clinical phenomenon influenced by age, genetics, and environmental variables. Although it is challenging to predict the rate of an individual's ovarian reserve decline, clinicians are often asked for advice about fertility potential and/or recommendations regarding the pursuit of fertility treatment options. The purpose of this review is to summarize the state-of-the-art of ovarian reserve testing, providing a guide for the obstetrician/gynecologist generalist and reproductive endocrinologist. The ideal ovarian reserve test should be convenient, be reproducible, display little if any intracycle and intercycle variability, and demonstrate high specificity to minimize the risk of wrongly diagnosing women as having diminished ovarian reserve and accurately identify those at greatest risk of developing ovarian hyperstimulation prior to fertility treatment. Evaluation of ovarian reserve can help to identify patients who will have poor response or hyperresponse to ovarian stimulation for assisted reproductive technology. Ovarian reserve testing should allow individualization of treatment protocols to achieve optimal response while minimizing safety risks. Ovarian reserve testing may inform patients regarding their reproductive lifespan and menopausal timing as well as aid in the counselling and selection of treatment for female cancer patients of reproductive age who receive gonadotoxic therapy. In addition, it may aid in establishing the diagnosis of polycystic ovary syndrome and provide insight into its severity. While there is currently no perfect ovarian reserve test, both antral follicular count and antimüllerian hormone have good predictive value and are superior to day-3 follicle-stimulating hormone. The convenience of untimed sampling, age-specific values, availability of an automated platform, and potential standardization of antimüllerian hormone assay make this test the preferred biomarker for the evaluation of ovarian reserve in women.
卵巢储备是一个复杂的临床现象，受年龄、遗传和环境变量的影响。尽管预测个体卵巢储备下降的速度具有挑战性，但临床医生经常被要求提供关于生育能力的建议和/或关于寻求生育治疗选择的建议。本综述的目的是总结卵巢储备测试的最新技术，为妇产科医生和生殖内分泌学家提供指导。理想的卵巢储备测试应该方便、可重复，周期内和周期间的变异性很小，如果有的话，并且特异性高，以最大程度地降低误诊为卵巢储备减少的风险，并准确识别那些在接受生育治疗前发生卵巢过度刺激的风险最大的患者。卵巢储备评估有助于识别对卵巢刺激反应不良或过度反应的患者，以实现最佳反应，同时最小化安全风险。卵巢储备测试可以告知患者关于其生殖寿命和绝经时间，以及在接受性腺毒性治疗的生殖年龄女性癌症患者的咨询和治疗选择方面提供帮助。此外，它可以帮助确定多囊卵巢综合征的诊断，并深入了解其严重程度。虽然目前没有完美的卵巢储备测试，但窦卵泡计数和抗苗勒管激素都具有良好的预测价值，并且优于基础促卵泡激素。抗苗勒管激素检测的优势在于无需定时采样、具有年龄特异性值、可实现自动化平台以及可能标准化抗苗勒管激素检测，使其成为评估女性卵巢储备的首选生物标志物。
