Izhar Rubina, Husain Samia, Tahir Muhammad Ahmad, Kausar Mauzma, Sana Tanveer, Ghalib Farrah
Obstetrics and Gynaecology, Aziz Medical Centre, Karachi, Pakistan.
Obstetrics and Gynaecology, Kharadar General Hospital, Pakistan.
J Ultrason. 2021 Aug 16;21(86):e200-e205. doi: 10.15557/JoU.2021.0032. Epub 2021 Sep 9.
To compare the rate of ovarian hyperstimulation syndrome in women with and without polycystic ovarian syndrome, and to determine the cut-off for the antral follicle count and the anti-Müllerian hormone level predictive of ovarian hyperstimulation syndrome in both groups. This was a prospective cohort study conducted in women aged 20-35 years who were undergoing controlled ovarian stimulation. The women were divided into those with polycystic ovarian syndrome and the controls on the basis of the Rotterdam criteria. The outcome of stimulation was recorded, and the ovarian response markers were compared in both groups. Among 689 women included in the study, 276 (40.1%) had polycystic ovarian syndrome, and 476 (59.9%) were used as the controls. Ovarian hyperstimulation syndrome occurred in 19.6% of the cases, and in 7.7% of the controls ( <0.001). The conception rate was greater in the group of cases (52.5% vs. 16.5%, = 0.001). Among the cases, the sensitivity and specificity for the prediction of hyper-response were 94.4% and 97.3% for AFC, and 92.6% and 93.7% for the anti-Müllerian hormone, at the cut-off values of ≥18 and ≥6.425 ng/ml, respectively. Among the controls, the sensitivity and specificity for the prediction of hyper-response were 93.8% and 97.1% for the antral follicle count, and 93.6% and 94.5% for the anti-Müllerian hormone, at the cut-off values of ≥10 and ≥3.95 ng/ml, respectively. Group-specific values should be used to identify and counsel women undergoing controlled ovarian stimulation. In light of available evidence, gynaecologists should be trained to perform ultrasound evaluation, determine the antral follicle count of their patients, and offer them appropriate counselling.
比较患有和未患有多囊卵巢综合征的女性发生卵巢过度刺激综合征的比率，并确定两组中预测卵巢过度刺激综合征的窦卵泡计数和抗苗勒管激素水平的临界值。这是一项针对年龄在20 - 35岁接受控制性卵巢刺激的女性进行的前瞻性队列研究。根据鹿特丹标准将这些女性分为多囊卵巢综合征患者组和对照组。记录刺激结果，并比较两组的卵巢反应标志物。在纳入研究的689名女性中，276名（40.1%）患有多囊卵巢综合征，476名（59.9%）作为对照组。卵巢过度刺激综合征在19.6%的病例中发生，在7.7%的对照组中发生（P<0.001）。病例组的受孕率更高（52.5%对16.5%，P = 0.001）。在病例组中，对于高反应预测，当窦卵泡计数的临界值≥18且抗苗勒管激素的临界值≥6.425 ng/ml时，敏感性和特异性分别为94.4%和97.3%；对于抗苗勒管激素，敏感性和特异性分别为92.6%和93.7%。在对照组中，当窦卵泡计数的临界值≥10且抗苗勒管激素的临界值≥3.95 ng/ml时，对于高反应预测，窦卵泡计数的敏感性和特异性分别为93.8%和97.1%，抗苗勒管激素的敏感性和特异性分别为93.6%和94.5%。应使用特定组的值来识别和咨询接受控制性卵巢刺激的女性。根据现有证据，应培训妇科医生进行超声评估、确定患者的窦卵泡计数并为她们提供适当的咨询。
