Inal Zeynep Ozturk, Engin Ustun Yaprak, Yilmaz Nafiye, Aktulay Ayla, Bardakci Yesim, Gulerman Cavidan
a Department of Reproductive Endocrinology , Konya Education and Research Hospital , Konya , Turkey.
b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey.
J Obstet Gynaecol. 2019 May;39(4):516-521. doi: 10.1080/01443615.2018.1533542. Epub 2019 Feb 11.
In this study, our aim was to determine which factor is more correlated with the number of oocytes retrieved in patients with endometrioma compared with controls undergoing in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles: antral follicle count (AFC) or anti-Müllerian hormone (AMH). A total of 60 women with endometrioma and a control population of 60 women without endometrioma in the same period were randomly selected underwent the injection IVF-ICSI treatment. No significant differences were found between the groups in terms of age (28.78 ± 3.49 vs. 29.52 ± 2.47, p = .187), body mass index (23.62 ± 2.05 vs. 23.91 ± 2.11, p = .449), duration of infertility [(3 (2-4) vs. 3 (2-3), p = .139)], AMH level (1.52 ± 0.51 vs. 1.32 ± 0.92, p = .133), duration of stimulation [(9 (9-10) vs. 10 (9-10), p = .135)], total gonadotropin dose [(2750 (2262.5-3337.5) vs. 2770 (2680-3562.5), p = .125)], endometrial thickness [(10 (10-11) vs. 10 (9-11), p = .463)], fertilisation rates (67.20 ± 18.04 vs. 62.28 ± 17.13, p = .123), grade I embryo (43.3% vs. 30%, p = .185), clinical pregnancy rates (40% vs. 26.7%, p = .123), and the perinatal outcomes between the groups. The AFC was higher in the controls than in those with endometrioma (9.20 ± 1.80 vs. 6.32 ± 2.04, p < .001). The number of oocytes retrieved was also higher in the controls than in those with endometrioma [(7 (6-8) vs. 4 (4-5.75), p < .001)]. We found that women with endometrioma had a significantly lower number of oocytes retrieved than the controls despite the same AMH levels in both groups. AFC is a better marker of ovarian response than AMH in women with endometrioma undergoing IVF-ICSI. Impact statement What is already known on this subject? Utilising the ovarian reserve is important in the success of ovarian stimulation and in evaluating the success of assisted reproductive technologies. The anti-Müllerian hormone (AMH) level and the antral follicle count (AFC) are widely used in the prediction of ovarian functional reserve and response. However, no perfect marker exists in the evaluation of ovarian reserve and ovarian response. What do the results of this study add? Our study demonstrated that women with endometrioma have a significantly lower number of oocytes retrieved than the controls, despite the same AMH levels in both groups; which strongly suggests that AFC is a better reflection of ovarian response than AMH in women with endometrioma undergoing an in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI). What are the implications of these findings for clinical practice and/or further research? This important issue has been reviewed and discussed for years, however, the conclusions are still controversial. Additional research is needed to understand which ovarian reserve test could better predict ovarian response outcome?
在本研究中，我们的目的是确定与接受体外受精-卵胞浆内单精子注射（IVF-ICSI）周期的对照组相比，子宫内膜异位症患者中哪个因素与取卵数的相关性更强：窦卵泡计数（AFC）还是抗苗勒管激素（AMH）。总共随机选取了60例患有子宫内膜异位症的女性和同期60例无子宫内膜异位症的女性作为对照人群，接受IVF-ICSI注射治疗。两组在年龄（28.78±3.49岁 vs. 29.52±2.47岁，p = 0.187）、体重指数（23.62±2.05 vs. 23.91±2.11，p = 0.449）、不孕持续时间[（3（2 - 4）年 vs. 3（2 - 3）年，p = 0.139）]、AMH水平（1.52±0.51 vs. 1.32±0.92，p = 0.133）、促排卵持续时间[（9（9 - 10）天 vs. 10（9 - 10）天，p = 0.135）]、总促性腺激素剂量[（2750（2262.5 - 3337.5）IU vs. 2770（2680 - 3562.5）IU，p = 0.125）]、子宫内膜厚度[（10（10 - 11）mm vs. 10（9 - 11）mm，p = 0.463）]、受精率（67.20±18.04% vs. 62.28±17.13%，p = 0.123）、I级胚胎率（43.3% vs. 30%，p = 0.185）、临床妊娠率（40% vs. 26.7%，p = 0.123）以及两组围产期结局方面均未发现显著差异。对照组的AFC高于子宫内膜异位症患者（9.20±1.80个 vs. 6.32±2.04个，p < 0.001）。对照组的取卵数也高于子宫内膜异位症患者[（7（6 - 8）个 vs. 4（4 - 5.75）个，p < 0.001）]。我们发现，尽管两组的AMH水平相同，但患有子宫内膜异位症的女性取卵数明显低于对照组。对于接受IVF-ICSI的子宫内膜异位症女性，AFC比AMH更能准确反映卵巢反应。影响声明关于该主题已知的信息有哪些？在卵巢刺激的成功以及评估辅助生殖技术的成功方面，利用卵巢储备很重要。抗苗勒管激素（AMH）水平和窦卵泡计数（AFC）广泛用于预测卵巢功能储备和反应。然而，在评估卵巢储备和卵巢反应方面不存在完美的标志物。本研究结果有何新发现？我们的研究表明，尽管两组的AMH水平相同，但患有子宫内膜异位症的女性取卵数明显低于对照组；这强烈表明，对于接受体外受精-卵胞浆内单精子注射（IVF-ICSI）的子宫内膜异位症女性，AFC比AMH更能反映卵巢反应。这些发现对临床实践和/或进一步研究有何意义？这个重要问题已经被回顾和讨论多年，然而结论仍然存在争议。需要进一步的研究来了解哪种卵巢储备测试能更好地预测卵巢反应结果？
