Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore.
The O&G Specialist Clinic, Singapore.
Singapore Med J. 2020 Sep;61(9):463-468. doi: 10.11622/smedj.2020130.
Ovarian biomarkers have been shown to predict responses to controlled ovarian hyperstimulation (COH) during in vitro fertilisation (IVF) in predominantly Caucasian populations, with limited studies performed in Southeast Asian women in Singapore.
We evaluated the performance of serum anti-Müllerian hormone (AMH), follicle-stimulating hormone and oestradiol levels, antral follicle count (AFC), body mass index, ovarian volume, and age to establish thresholds for the prediction of poor (< 4 oocytes retrieved) and excessive responses (> 19 oocytes retrieved) in 263 women undergoing COH. Univariate and multivariate logistic regression analysis and receiver operating characteristic curves were used to calculate probabilities for poor and excessive responders to COH.
36 (13.7%) and 50 (19.0%) women had poor and excessive response to COH, respectively. An AMH value of 0.69 ng/mL predicted poor ovarian response with positive likelihood ratio (LR) of 2.94, compared to an AFC of ≤ 5 when the positive LR is 2.36. Conversely, an AMH value of ≥ 3.06 ng/mL predicted excessive ovarian response with positive LR of 2.24, compared to an AFC cut-off of ≥ 12 with positive LR of 1.93.
AMH levels and AFC are equivalent in the prediction of both poor and excessive ovarian response in women undergoing IVF. Our study highlights the importance of establishing population-specific cut-off biomarker values so that protocols can be tailored to optimise IVF treatment.
在体外受精（IVF）中，卵巢生物标志物已被证明可预测在主要为白种人群中控制性卵巢过度刺激（COH）的反应，而在新加坡的东南亚女性中进行的相关研究有限。
我们评估了血清抗苗勒管激素（AMH）、卵泡刺激素和雌二醇水平、窦卵泡计数（AFC）、体重指数、卵巢体积和年龄对 263 名接受 COH 的女性中预测低反应（<4 个卵母细胞回收）和高反应（>19 个卵母细胞回收）的表现，采用单变量和多变量逻辑回归分析和受试者工作特征曲线来计算 COH 低反应和高反应者的概率。
分别有 36 名（13.7%）和 50 名（19.0%）女性对 COH 有低反应和高反应。AMH 值为 0.69ng/mL 预测卵巢低反应的阳性似然比（LR）为 2.94，而 AFC 值≤5 的阳性 LR 为 2.36。相反，AMH 值≥3.06ng/mL 预测卵巢高反应的阳性 LR 为 2.24，而 AFC 截断值≥12 的阳性 LR 为 1.93。
在进行 IVF 的女性中，AMH 水平和 AFC 在预测低反应和高反应方面具有同等作用。我们的研究强调了建立特定人群的生物标志物截断值的重要性，以便可以针对个体优化 IVF 治疗方案。
