Seyam Emaduldin, Hefzy Enas
Obstetrics and Gynecology Department, Minia University College of Medicine, Minia, Egypt.
Microbiology and Immunology Department, Fayoum University College of Medicine, Fayoum, Egypt.
Eur J Obstet Gynecol Reprod Biol. 2018 Mar;222:126-133. doi: 10.1016/j.ejogrb.2018.01.011. Epub 2018 Feb 3.
Laparoscopic ovarian drilling (LOD) is still a controversial decision; due to the long term hazards; so short and long term predictors after the procedure should be taken in consideration. The aim of this work was to investigate the role of the serum level of tumor necrosis factor alpha (TNF-α) and other polycystic ovarian disease (PCOD) relevant clinical and biochemical factors as a predictor of spontaneous ovulation after laparoscopic ovarian drilling (LOD) in women with clomiphene citrate resistant polycystic ovarian disease (CCR-PCOD).
It was a prospective research work, where 150 infertile women with CCR-PCOD had been recruited. TNF-α serum level, which is an inflammatory biomarker, was investigated in addition to other PCOD relevant clinical and biochemical parameters as possible predictors of successful spontaneous ovulation and subsequent pregnancy after LOD.
Recruited women with higher preoperative levels of TNF-α, LH, and androstenedione had significantly higher rates of spontaneous ovulation within the first three months follow up after LOD, in contrast to obese women with BMI ≥ 25 kg/m2, long duration of infertility ≥3 years, marked biochemical hyperandrogenism (testosterone levels ≥4.5 nmol/L, free androgen index ≥15), and high insulin resistance (IR). Ninty five (95 = 63.3%) women in between women regularly menstruated (105 = 70%) had spontaneous ovulation, and of those spontaneously ovulated, 35(36.8%) women got pregnant spontaneously during the first 3 months follow up. Extended follow up for 12 months period revealed that 61 women got pregnant, with cumulative pregnancy rate of 58%. Logistic regression showed that the best cut-off values for spontaneous ovulation after LOD were 65.1 pg/ml, 11.5 IU/l, and 3.1 ng/ml and with a sensitivity of 91%, 88%, 55%, and with a specificity of 85%, 79%, 78%, for TNF-α, LH, androstenedione serum level respectively.
TNF-α, LH, and Androstenedione could be considered as reliable predictors to depend on for recruiting the ideal women candidates with CCR-PCOD; to have the maximum benefits after LOD treatment option.
由于存在长期风险，腹腔镜卵巢打孔术（LOD）仍是一个有争议的决定；因此应考虑该手术后的短期和长期预测因素。本研究的目的是探讨肿瘤坏死因子α（TNF-α）血清水平以及其他多囊卵巢疾病（PCOD）相关的临床和生化因素在枸橼酸氯米芬抵抗性多囊卵巢疾病（CCR-PCOD）女性患者腹腔镜卵巢打孔术（LOD）后自发排卵预测中的作用。
这是一项前瞻性研究，招募了150例CCR-PCOD不孕女性。除了其他与PCOD相关的临床和生化参数外，还研究了作为炎症生物标志物的TNF-α血清水平，以作为LOD后成功自发排卵及随后妊娠的可能预测指标。
术前TNF-α、LH和雄烯二酮水平较高的招募女性在LOD后的前三个月随访中自发排卵率显著更高，而BMI≥25kg/m²的肥胖女性、不孕时间≥3年、明显的生化高雄激素血症（睾酮水平≥4.5nmol/L，游离雄激素指数≥15）和高胰岛素抵抗（IR）的女性则相反。在月经规律的女性（105例，占70%）中，有95例（95例，占63.3%）自发排卵，在这些自发排卵的女性中，有35例（36.8%）在随访的前3个月内自然受孕。延长至12个月的随访显示，有61例女性怀孕，累积妊娠率为58%。逻辑回归显示，LOD后自发排卵的最佳截断值分别为TNF-α血清水平65.1pg/ml、LH 11.5IU/l和雄烯二酮3.1ng/ml，敏感性分别为91%、88%、55%，特异性分别为85%、79%、78%。
TNF-α、LH和雄烯二酮可被视为可靠的预测指标，用于筛选CCR-PCOD的理想女性候选者，以便在LOD治疗方案后获得最大益处。
