Pataia Vanessa, Nair Shailaja, Wolska Marta, Linara-Demakakou Elena, Shah Trina, Lamanna Giuseppina, Macklon Nick, Ahuja Kamal K
London Egg Bank, London Women's Clinic, 113-115 Harley Street, London W1G 6AP, UK.
London Egg Bank, London Women's Clinic, 113-115 Harley Street, London W1G 6AP, UK.
Reprod Biomed Online. 2021 Sep;43(3):453-465. doi: 10.1016/j.rbmo.2021.05.015. Epub 2021 May 24.
Do donor age, AMH, AFC, BMI and reproductive history predict response to ovarian stimulation? Do donor and recipient clinical markers and embryology parameters predict recipient pregnancy and live birth?
Retrospective cohort study of 494 altruistic oocyte donors aged 18-35 years; 340 were matched to 559 recipients. Predictors of donor total oocyte yield and total mature oocyte yield were identified. Total and mature oocyte number were compared according to stratified donor AMH and age. Donor, recipient and embryology parameters predictive of recipient primary outcomes (clinical pregnancy and live birth) were identified.
Donor age and AMH predicted total oocyte yield (P = 0.030 and P < 0.001)) and total mature oocyte yield (P = 0.011 and P < 0.001). Donors aged 30-35 years with AMH 15-29.9 pmol/l had lower total oocyte yield (P = 0.004) and mature oocyte yield (P < 0.001) than donors aged 18-24 years. Up to an AMH threshold of 39.9 pmol/l, increasing AMH levels predicted higher total oocyte yield (<15 pmol/l versus 15-29.9 pmol/l, P = 0.001; 15-29.9 pmol/l versus 30-39.9 pmol/l, P < 0.001; 30-39.9pmol/l versus ≥ 40 pmol/l, P = 1.0) and mature oocyte yield (<15 pmol/l versus 15-29.9 pmol/l, P = 0.005; 15-29.9 pmol/l versus 30-39.9 pmol/l, P = 0.006; 30-39.9 pmol/l versus ≥40 pmol/l, P = 1.0). In recipients, the rate of transferrable embryos per oocytes received, fertilized and number of embryo transfers needed to achieve the primary outcome were predictors of cumulative clinical pregnancy (P = 0.011, P = 0.017 and P < 0.001) and live birth (P = 0.008, P = 0.012 and P < 0.001) rates. Recipient BMI (P = 0.024) and previous miscarriages (P = 0.045) were predictors of cumulative live birth rate. Donor age 18-22 years was associated with a lower incidence of recipient clinical pregnancy (P = 0.004) and live birth (P = 0.001) after the first embryo transfer versus donor age 23-29 years.
Donor age and AMH are independent predictors of oocyte yield. Raised recipient BMI and history of miscarriages reduce cumulative live birth rates, which may be increased by selecting donors aged 23-29 years, instead of younger donors.
供体年龄、抗缪勒氏管激素（AMH）、窦卵泡计数（AFC）、体重指数（BMI）和生育史能否预测卵巢刺激反应？供体和受体的临床指标以及胚胎学参数能否预测受体的妊娠和活产情况？
对494名年龄在18 - 35岁的利他性卵母细胞供体进行回顾性队列研究；其中340名供体与559名受体进行了匹配。确定了供体总卵母细胞产量和总成熟卵母细胞产量的预测因素。根据分层后的供体AMH和年龄比较了总卵母细胞数和成熟卵母细胞数。确定了预测受体主要结局（临床妊娠和活产）的供体、受体和胚胎学参数。
供体年龄和AMH可预测总卵母细胞产量（P = 0.030，P < 0.001）和总成熟卵母细胞产量（P = 0.011，P < 0.001）。与18 - 24岁的供体相比，年龄在30 - 35岁且AMH为15 - 29.9 pmol/L的供体总卵母细胞产量（P = 0.004）和成熟卵母细胞产量（P < 0.001）较低。在AMH阈值达到39.9 pmol/L之前，AMH水平升高预示着总卵母细胞产量更高（<15 pmol/L与15 - 29.9 pmol/L相比，P = 0.001；15 - 29.9 pmol/L与30 - 39.9 pmol/L相比，P < 0.001；30 - 39.9 pmol/L与≥40 pmol/L相比，P = 1.0）以及成熟卵母细胞产量更高（<15 pmol/L与15 - 29.9 pmol/L相比，P = 0.005；15 - 29.9 pmol/L与30 - 39.9 pmol/L相比，P = 0.006；30 - 39.9 pmol/L与≥40 pmol/L相比，P = 1.0）。在受体中，每接受的卵母细胞中可移植胚胎的比例、受精情况以及实现主要结局所需的胚胎移植次数是累积临床妊娠率（P = 0.011，P = 0.017，P < 0.001）和活产率（P = 0.008，P = 0.012，P < 0.001）的预测因素。受体BMI（P = 0.024）和既往流产史（P = 0.045）是累积活产率的预测因素。与23 - 29岁的供体相比，18 - 22岁的供体在首次胚胎移植后受体临床妊娠（P = 0.004）和活产（P = 0.001）的发生率较低。
供体年龄和AMH是卵母细胞产量的独立预测因素。受体BMI升高和流产史会降低累积活产率，选择23 - 29岁的供体而非更年轻的供体可能会提高累积活产率。
