Department of Gynecology and Obstetrics, Cairo University, 1 Alsaraya street AlKasr AlAiny, Cairo, Egypt.
Department of Gynecology and Obstetrics, Ain Shams University, Ramsis street, Abassiya, Cairo, Egypt.
J Assist Reprod Genet. 2017 Oct;34(10):1317-1324. doi: 10.1007/s10815-017-0984-5. Epub 2017 Jul 3.
This study aims to introduce a new tool (the Follicular Sensitivity Index; FSI) for objective assessment of follicular responsiveness to exogenous gonadotropins and to evaluate its ability to predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI.
FSI was calculated as preovulatory follicle count (PFC) × 100,000/[antral follicle count (AFC) × total received FSH doses]. One thousand women were included and were divided according to the FSI tertile values into three groups. The primary outcome was clinical pregnancy defined by the presence of an intrauterine gestational sac 5 weeks after embryo transfer.
There was progressive increase in the clinical pregnancy rate from the low to the high FSI groups (0.27 ± 0.4 vs 0.4 ± 0.4 and 0.58 ± 0.4; p < 0.001). Receiver operator curves showed that FSI had a greater area under the curve than those of the AFC, PFC, and the FSH dose (0.638 vs 0.509, 0.538, and 0.589 respectively). Multivariate logistic regression analysis showed that the correlation between FSI and pregnancy was independent of potential confounding factors like age and body mass index (p < 0.001).
FSI can predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI using GnRH agonist protocol. Higher FSI values had significantly higher oocyte yield and fertilization and clinical pregnancy rates. Wider implications of these findings include the potential use of FSI to define absolute criteria of poor/good ovarian response in IVF/ICSI cycles, guide future IVF cycle management for the same couples, and guide cycle cancelation criteria for poor ovarian response.
本研究旨在介绍一种新的工具（卵泡敏感性指数；FSI），用于客观评估外源性促性腺激素对卵泡的反应性，并评估其预测不明原因不孕或输卵管因素行 IVF/ICSI 妇女临床妊娠率的能力。
FSI 计算为早卵泡期卵泡计数（PFC）×100,000/[窦卵泡计数（AFC）×总接受 FSH 剂量]。共纳入 1000 例患者，并根据 FSI 三分位值分为三组。主要结局为胚胎移植后 5 周时存在宫内妊娠囊的临床妊娠。
从低 FSI 组到高 FSI 组，临床妊娠率逐渐增加（0.27±0.4 比 0.4±0.4 和 0.58±0.4；p<0.001）。受试者工作特征曲线显示，FSI 的曲线下面积大于 AFC、PFC 和 FSH 剂量（0.638 比 0.509、0.538 和 0.589）。多变量逻辑回归分析显示，FSI 与妊娠的相关性独立于年龄和体重指数等潜在混杂因素（p<0.001）。
FSI 可以预测 GnRH 激动剂方案行 IVF/ICSI 的不明原因不孕或输卵管因素妇女的临床妊娠率。较高的 FSI 值具有显著更高的卵母细胞产量、受精率和临床妊娠率。这些发现的更广泛意义包括 FSI 可能用于定义 IVF/ICSI 周期中卵巢反应不良/良好的绝对标准，指导同一夫妇未来的 IVF 周期管理，并指导卵巢反应不良的周期取消标准。
