Center for Reproductive Medicine, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Obstetrics and Gynecology Department, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Front Endocrinol (Lausanne). 2022 Nov 15;13:1030201. doi: 10.3389/fendo.2022.1030201. eCollection 2022.
To explore the relative factors for best ovarian response in patients undergoing assisted reproductive technology with the gonadotropin-releasing hormone antagonist protocol and to establish a nomogram prediction model of ovarian response.
A retrospective cohort analysis of the clinical data of 1,944 patients who received assisted reproductive treatment in the Center for Reproductive Medicine of Fujian Maternity and Child Health Hospital from April 1, 2018, to June 30, 2020. According to the number of oocytes obtained, there were 659 cases in the low ovarian response group (no more than five oocytes were retrieved), 920 cases in the normal ovarian response group (the number of retrieved oocytes was >5 but ≤18), and 365 cases in the high ovarian response group (>18 oocytes retrieved). Independent factors affecting ovarian responsiveness were screened by logistic regression, which were the model entry variables, and a nomogram prediction model was established based on the regression coefficients.
There were statistically significant differences in age, anti-Mullerian hormone, antral follicle count, the diagnosis of endometriosis, decreased ovarian reserve, polycystic ovary syndrome, basal follicle-stimulating hormone and basal luteinizing hormone among the three groups (P < 0.001). Multifactorial stepwise regression analysis showed that female age (0.95 [0.92-0.97], = 0.000), decreased ovarian reserve (0.27 [0.19-0.38]), = 0.000), endometriosis (0.81 [0.56-0.86], = 0.000), antral follicle count (1.09 [1.06-1.12], = 0.000), basal follicle-stimulating hormone (0.90 [0.85-0.96], = 0.001), Anti-Mullerian hormone (1.19 [1.13-1.26], = 0.000) and luteinizing hormone on trigger day (0.73 [0.66-0.80], = 0.000), were independent factors for the occurrence of different ovarian responses during ovarian hyperstimulation. The predictive model of ovarian responsiveness was constructed based on the above factors, and the model was verified with 589 patients' data from July 1, 2020, to December 31, 2020, at this center. The predicted ovarian response (number of eggs obtained) of a total of 450 patients was consistent with the actual results, with a coincidence degree of 76.4%, and the consistency index of the model is 0.77.
The nomogram model was successfully developed to effectively, intuitively, and visually predict the ovary reactivity in the gonadotropin-releasing hormone antagonist protocol and provide guidance for clinical practice.
探讨应用促性腺激素释放激素拮抗剂方案行辅助生殖技术中卵巢反应的相关因素，并建立卵巢反应预测的列线图模型。
回顾性分析 2018 年 4 月 1 日至 2020 年 6 月 30 日在福建省妇幼保健院生殖医学中心接受辅助生殖治疗的 1944 例患者的临床资料。根据获卵数分为卵巢低反应组（取卵数≤5 枚）659 例、卵巢正常反应组（取卵数>5 枚且≤18 枚）920 例、卵巢高反应组（取卵数>18 枚）365 例。采用 logistic 回归筛选影响卵巢反应性的独立因素，将其作为模型的纳入变量，基于回归系数建立列线图预测模型。
三组间年龄、抗苗勒管激素（AMH）、窦卵泡计数、子宫内膜异位症诊断、卵巢储备功能减退、多囊卵巢综合征、基础卵泡刺激素（FSH）、基础黄体生成素（LH）比较，差异均有统计学意义（P<0.001）。多因素逐步回归分析显示，女性年龄（0.95[0.920.97]， =0.000）、卵巢储备功能减退（0.27[0.190.38]， =0.000）、子宫内膜异位症（0.81[0.560.86]， =0.000）、窦卵泡计数（1.09[1.061.12]， =0.000）、基础 FSH（0.90[0.850.96]， =0.001）、AMH（1.19[1.131.26]， =0.000）和扳机日 LH（0.73[0.66~0.80]， =0.000）是卵巢刺激中不同卵巢反应发生的独立影响因素。基于上述因素构建卵巢反应性预测模型，并对 2020 年 7 月 1 日至 12 月 31 日中心的 589 例患者数据进行验证。共 450 例患者的预测卵巢反应（获卵数）与实际结果相符，符合率为 76.4%，模型的一致性指数为 0.77。
成功建立了预测 GnRH 拮抗剂方案卵巢反应性的列线图模型，可有效、直观、可视化地预测卵巢反应性，为临床实践提供指导。
