Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel..
Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
Reprod Biomed Online. 2024 Jul;49(1):103852. doi: 10.1016/j.rbmo.2024.103852. Epub 2024 Jan 30.
What clinical factors are associated with 'unexpected' poor or suboptimal responses to IVF ovarian stimulation per POSEIDON's criteria, and which AMH and AFC threshold values distinguish this population?
Tri-centre retrospective cohort study (2015-2017) involving first-time IVF and ICSI cycles with conventional ovarian stimulation (≥150 IU/day of FSH). Eligibility criteria included sufficient ovarian reserve markers according to POSEIDON's classification (AMH ≥1.2 ng/ml; AFC ≥5). Ovarian response categories were poor (<4 oocytes), suboptimal (4-9 oocytes) and normal (≥9 oocytes). Primary outcomes included clinical factors associated with an unexpected poor or suboptimal response to conventional ovarian stimulation using logistic regression analyses, and the threshold values of AMH and AFC predicting increased risk of such responses using ROC curves.
A total of 7625 patients met the inclusion criteria: 204 (9.3%) were poor and 1998 (90.7%) were suboptimal responders. Logistic regression identified significant clinical predictors for a poor or suboptimal response, including AFC, AMH, total gonadotrophin dose, gonadotrophin type and trigger type (P ≤ 0.02). The ROC curves indicated that AMH 2.87 ng/ml (AUC 0.740) and AFC 12 (AUC 0.826) were the threshold values predicting a poor or suboptimal response; AMH 2.17 ng/ml (AUC 0.741) and AFC 9 (AUC 0.835) predicted a poor response; and AMH 2.97 ng/ml (AUC 0.722) and AFC 12 (AUC 0.801) predicted a suboptimal response.
The threshold values of AMH and AFC predicting 'unexpected' poor or suboptimal response were higher than expected. These findings have critical implications for tailoring IVF stimulation regimens and dosages.
根据 POSEIDON 标准，哪些临床因素与 IVF 卵巢刺激的“意外”不良或不理想反应相关，以及哪些 AMH 和 AFC 阈值值可以区分这部分人群？
一项涉及首次 IVF 和 ICSI 周期的三中心回顾性队列研究（2015-2017 年），采用常规卵巢刺激（≥150IU/天 FSH）。入选标准包括根据 POSEIDON 分类有足够的卵巢储备标志物（AMH≥1.2ng/ml；AFC≥5）。卵巢反应类别为不良（<4 个卵母细胞）、次优（4-9 个卵母细胞）和正常（≥9 个卵母细胞）。主要结局包括使用逻辑回归分析确定与常规卵巢刺激的意外不良或不理想反应相关的临床因素，以及使用 ROC 曲线确定 AMH 和 AFC 的阈值值预测此类反应的风险增加。
共有 7625 名患者符合纳入标准：204 名（9.3%）为不良反应者，1998 名（90.7%）为次优反应者。逻辑回归确定了不良或次优反应的显著临床预测因素，包括 AFC、AMH、总促性腺激素剂量、促性腺激素类型和触发类型（P≤0.02）。ROC 曲线表明，AMH 2.87ng/ml（AUC 0.740）和 AFC 12（AUC 0.826）是预测不良或次优反应的阈值值；AMH 2.17ng/ml（AUC 0.741）和 AFC 9（AUC 0.835）预测不良反应；AMH 2.97ng/ml（AUC 0.722）和 AFC 12（AUC 0.801）预测次优反应。
预测“意外”不良或次优反应的 AMH 和 AFC 阈值值高于预期。这些发现对制定 IVF 刺激方案和剂量具有重要意义。
