每个卵巢内的窦卵泡直径差异可能是卵巢储备功能正常的患者反应不良的一个预测指标。
Antral Follicle Diameter Variance Within Each Ovary May Be A Predictor For Poor Response In Cases With Normal Ovarian Reserve.
作者信息
Sanverdi Ilhan, Ozkaya Enis, Kucur Suna Kabil, Bilen Dilsat, Eken Meryem Kurek, Bilgic Bulent Emre
机构信息
Zeynep Kamil Women and Children's Health Training and Research Hospital.
出版信息
Exp Clin Endocrinol Diabetes. 2018 Sep;126(8):521-527. doi: 10.1055/s-0043-125404. Epub 2018 Jan 31.
OBJECTIVES
To determine the predictive value of antral follicle diameter variance within each ovary for ovarian response in cases with normal ovarian reserve tests.
METHODS
This is a prospective observational study. One hundred and thirty nine infertile women who underwent ART in IVF-ICSI unit of Zeynep Kamil women and children's Health Training and research hospital between January 2017 to June 2017 were recruited. Blood samples were collected on day 2/day 3 for assessment of serum FSH and estradiol. Trans-vaginal sonography was done for antral follicle count. During antral follicle count, in order to determine antral follicle diameter variance, diameters of the largest and smallest follicles were recorded. Variance was calculated by subtracting the smallest diameter from the largest one. Following ovarian stimulation with antagonist protocol, poor response was determined in cases with total oocyte number≤3. Ovarian reserve tests and antral follicle diameter variance were utilized to predict cases with poor response in women with normal ovarian reserve.
RESULTS
Antral follicle diameter variance both in right (AUC=0.737, P<0.001) and left (AUC=0.651, P<0.05) ovaries significantly predicted poor ovarian response. Variance>3.5 mm was found to have 75% sensitivity to predict poor response. Basal serum FSH with estradiol levels and AFC failed to predict poor response (P>0.05). Other significant predictors for poor response were day 5 estradiol level and estradiol level at trigger day (P<0.05). In multivariate regression analysis, both AFC and antral follicle diameter variance in the right ovary were found to be significantly associated with clinical pregnancy, on the other hand peak estradiol concentration and antral follicle diameter variance in the right ovary were significantly associated with poor response.
CONCLUSION
Antral follicle diameter variance may be utilized to predict poor ovarian response in cases with normal ovarian reserve.
目的
确定在卵巢储备功能检测正常的情况下，每个卵巢内窦卵泡直径差异对卵巢反应的预测价值。
方法
这是一项前瞻性观察研究。招募了2017年1月至2017年6月期间在泽伊内普·卡米尔妇女儿童医院体外受精 - 卵胞浆内单精子注射（IVF - ICSI）单元接受辅助生殖技术（ART）的139名不孕妇女。在第2天/第3天采集血样以评估血清促卵泡生成素（FSH）和雌二醇。经阴道超声检查进行窦卵泡计数。在窦卵泡计数期间，为了确定窦卵泡直径差异，记录最大和最小卵泡的直径。差异通过用最大直径减去最小直径来计算。采用拮抗剂方案进行卵巢刺激后，总卵母细胞数≤3的病例被判定为反应不良。利用卵巢储备功能检测和窦卵泡直径差异来预测卵巢储备功能正常的女性中反应不良的病例。
结果
右侧卵巢（曲线下面积[AUC]=0.737，P<0.001）和左侧卵巢（AUC=0.651，P<0.05）的窦卵泡直径差异均能显著预测卵巢反应不良。发现差异>3.5 mm对预测反应不良具有75%的敏感性。基础血清FSH与雌二醇水平及窦卵泡计数未能预测反应不良（P>0.05）。其他反应不良的显著预测因素为第5天雌二醇水平和扳机日雌二醇水平（P<0.05）。在多因素回归分析中，发现右侧卵巢的窦卵泡计数和窦卵泡直径差异均与临床妊娠显著相关，另一方面，右侧卵巢的雌二醇峰值浓度和窦卵泡直径差异与反应不良显著相关。
结论
窦卵泡直径差异可用于预测卵巢储备功能正常的情况下卵巢反应不良。
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