Younis Johnny S, Yakovi Shiran, Izhaki Ido, Haddad Sami, Ben-Ami Moshe
Reproductive Medicine Unit, Department of Obstetrics & Gynecology, Poriya Medical Center, Tiberias, Israel; Faculty of Medicine in Galilee, Bar-Ilan University, Israel.
Reproductive Medicine Unit, Department of Obstetrics & Gynecology, Poriya Medical Center, Tiberias, Israel; Faculty of Medicine in Galilee, Bar-Ilan University, Israel.
Eur J Obstet Gynecol Reprod Biol. 2018 Jan;220:6-11. doi: 10.1016/j.ejogrb.2017.11.001. Epub 2017 Nov 3.
To investigate the occurrence of the "vanishing follicle" phenomenon in women with low number of developing follicles in assisted reproduction.
Women with ≤ 6 follicles on the day of hCG administration with ≥ 14mm diameter were prospectively studied. Primary outcome measures were disappearance of ≥14mm and all-diameter follicles on the day of oocyte pick-up compared to the day of hCG administration.
Among the 120 women recruited, 95 were found eligible and completed the study. The "vanishing follicle" phenomenon occurred in 3.1% (95% confidence level: 0.7%-9.0%) and 18.9% (95% confidence level: 11.6%-28.3%) of cases affecting ≥14mm and all-diameter follicles, respectively. In all cases, mid-late follicular serum LH and P levels remained within normal follicular phase range and trans-vaginal scan did not show signs of ovulation. Markedly, the main significant difference between the study and control groups in the ≥14mm follicle group was serum E level on the day of hCG administration; median (Interquartile range), corresponding to 395 (382.0-405.5) versus 823.0 (544.5-1291.0) pg/mL, respectively (P=0.04). The same trend was encountered in all-diameter vanishing follicles group but it did not reach significance. Interestingly, in all-diameter vanishing group, chronic smoking and the P/E ratio on the hCG day were significantly higher than controls. Post hoc multiple logistic regression analysis of data in accordance with the Bologna criteria reveled that antral follicle count was found to significantly affect the development of the "vanishing follicle" phenomenon.
The "vanishing follicle" phenomenon occasionally occurs in women with low number of developing follicles during assisted reproduction with no signs of ovulation. Our preliminary findings suggest that this phenomenon may be related to exhausted ovarian reserve however, an early-unrecognized LH elevation could not be ruled out.
探讨辅助生殖中发育卵泡数量少的女性出现“卵泡消失”现象的情况。
对人绒毛膜促性腺激素（hCG）注射日直径≥14mm的卵泡数≤6个的女性进行前瞻性研究。主要观察指标为与hCG注射日相比，取卵日直径≥14mm和所有直径卵泡的消失情况。
在招募的120名女性中，95名符合条件并完成研究。“卵泡消失”现象分别发生在3.1%（95%置信区间：0.7%-9.0%）和18.9%（95%置信区间：11.6%-28.3%）的病例中，分别影响直径≥14mm和所有直径的卵泡。在所有病例中，卵泡期中期至晚期血清促黄体生成素（LH）和孕酮（P）水平保持在正常卵泡期范围内，经阴道超声检查未显示排卵迹象。值得注意的是，在直径≥14mm卵泡组中，研究组和对照组之间的主要显著差异是hCG注射日的血清雌二醇（E）水平；中位数（四分位间距）分别为395（382.0-405.5）与823.0（544.5-1291.0）pg/mL（P=0.04）。在所有直径卵泡消失组中也遇到了相同趋势，但未达到显著水平。有趣的是，在所有直径卵泡消失组中，长期吸烟和hCG日的P/E比值显著高于对照组。根据博洛尼亚标准对数据进行事后多因素逻辑回归分析发现，窦卵泡计数显著影响“卵泡消失”现象的发生。
“卵泡消失”现象在辅助生殖中发育卵泡数量少且无排卵迹象的女性中偶尔发生。我们的初步研究结果表明，这种现象可能与卵巢储备耗竭有关，然而，不能排除早期未被识别的LH升高。
