Ozyurek Eser Sefik, Yoldemir Tevfik, Artar Gokhan
Bagcilar Research and Training Hospital Obgyn Department, Merkez Mh., Mimar Sinan Caddesi, 6. Sokak, 34100 Bagcilar, Istanbul, Turkey.
Marmara University Teaching and Research Hospital Obgyn Department, Fevzicakmak District Muhsin Yazicioglu Street 10 Ustkaynarca Pendik, Istanbul, Turkey.
J Ovarian Res. 2017 May 12;10(1):34. doi: 10.1186/s13048-017-0330-7.
We aimed to test the hypothesis that the correlation of the changes in the blood Androstenedione (A) levels to the number of selected follicles during ovulation induction with low-dose recombinant human follicle stimulating hormone (rhFSH) is as strong as the correlation to changes in the blood Estradiol (E) levels in polycystic ovary syndrome (PCOS).
Prospective Case-control study conducted from October 2014 to January 2016. 61 non-PCOS control (Group I) and 46 PCOS (Group II) patients treated with the chronic low-dose step up protocosl with rhFSH. A, E, progesterone blood levels and follicular growth were monitored.. Univariate and hierarchical multivariable analysis were performed for age, BMI, HOMA-IR, A and E (with the number of selected follicles as the dependent variable in both groups). ROC analysis was performed to define threshold values for the significant determinants of the number of selected follicles to predict cyle cancellations due to excessive ovarian response.
The control group (Group I) was comprised of 61 cycles from a group of primary infertile non-PCOS patients, and the study group (Group II) of 46 cycles of PCOS patients. The analysis revealed that the strongest independent predictor of the total number of selected follicles in Group I was the E(AUC) (B = 0.0006[0.0003-0.001]; P < 0.001); whereas for Group II, it was the A (AUC) (B = 0.114[0.04-0.25]; P = 0.01). Optimum thresholds for the A related parameters were defined to predict excessive response within Group II were 88.7%, 3.1 ng/mL and 5.4 ng*days for the percentage increase in A, the maximum A value and area under the curve values for A, respectively.
A response to low-dose rhFSH in PCOS has a stronger association with the number of follicles selected than the E reponse. A response preceding the E response is essential for progressive follicle development. Monitoring A rather than E may be more preemptive to define the initial ovarian response and accurate titration of the rhFSH doses.
The study was registered as a prospective case-control study in the ClinicalTrials.gov registry with the identifier NCT02329483 .
我们旨在验证以下假设：在多囊卵巢综合征（PCOS）患者中，采用低剂量重组人促卵泡激素（rhFSH）进行排卵诱导时，血液中雄烯二酮（A）水平的变化与所选卵泡数量的相关性，与血液中雌二醇（E）水平的变化相关性一样强。
2014年10月至2016年1月进行前瞻性病例对照研究。61例非PCOS对照患者（I组）和46例PCOS患者（II组）接受慢性低剂量递增方案的rhFSH治疗。监测A、E、孕酮的血液水平和卵泡生长情况。对年龄、体重指数、胰岛素抵抗指数（HOMA-IR）、A和E进行单因素和分层多变量分析（两组均以所选卵泡数量作为因变量）。进行ROC分析以确定所选卵泡数量显著决定因素的阈值，以预测因卵巢过度反应导致的周期取消。
对照组（I组）包括一组原发性不孕非PCOS患者的61个周期，研究组（II组）包括46个PCOS患者的周期。分析显示，I组中所选卵泡总数的最强独立预测因素是E的曲线下面积（AUC）（B = 0.0006[0.0003 - 0.001]；P < 0.001）；而对于II组，是A的AUC（B = 0.114[0.04 - 0.25]；P = 0.01）。定义了II组中与A相关参数的最佳阈值，以预测过度反应，A增加百分比、A的最大数值和A的曲线下面积值分别为88.7%、3.1 ng/mL和5.4 ng·天。
PCOS患者对低剂量rhFSH的反应与所选卵泡数量的相关性比E反应更强。在E反应之前的A反应对于卵泡的渐进性发育至关重要。监测A而非E可能更有助于预先确定初始卵巢反应并准确调整rhFSH剂量。
该研究在ClinicalTrials.gov注册库中注册为前瞻性病例对照研究，标识符为NCT02329483。
Zotero 插件