Yin Huiqun, Zhu Jie, Wang Cunli, Luan Kang, Wu Yan, Ni Feng
Reproductive Medicine Centre, 901st Hospital of PLA Joint Logistics Support Force, Hefei, China; Prenatal Diagnosis Centre, 901st Hospital of PLA Joint Logistics Support Force, Hefei, China.
Reproductive Medicine Centre, 901st Hospital of PLA Joint Logistics Support Force, Hefei, China; Prenatal Diagnosis Centre, 901st Hospital of PLA Joint Logistics Support Force, Hefei, China.
Eur J Obstet Gynecol Reprod Biol. 2025 Jan;304:97-103. doi: 10.1016/j.ejogrb.2024.11.028. Epub 2024 Nov 22.
To investigate influencing factors and effects of low oocyte retrieval in patients with polycystic ovary syndrome (PCOS) undergoing in-vitro fertilization (IVF).
In total, 720 patients with PCOS undergoing IVF were enrolled in this retrospective study from January 2017 to December 2022. The oocyte retrieval rate (ORR) was defined as the ratio of the number of oocytes retrieved to the number of follicles ≥ 12 mm in diameter on the trigger day. Using 1 standard deviation from the mean ORR as the boundary value, patients were divided into low and normal ORR groups. Patient characteristics, stimulation protocols, serum hormone levels, oocyte maturity, embryo developmental quality, and pregnancy outcomes of fresh transfer cycles were analysed.
ORR ranged from 0.06 to 2.69, with a mean value of 1.02. Compared with the normal ORR group (ORR ≥ 0.65), patients in the low ORR group (ORR < 0.65) had a higher body mass index; higher antral follicle count (AFC); more days of gonadotrophin stimulation; and lower serum oestradiol (E2) level, lower progesterone level and lower E2 level/follicle (≥12 mm) on the trigger day. Multivariate logistic regression analysis showed AFC [adjusted odds ratio (aOR) 1.05, 95 % confidence interval (CI) 1.0120-1.0940], E2 level/follicle (≥12 mm) (aOR 0.99, 95 % CI 0.9888-0.9972) and progesterone level (aOR 0.41, 95 % CI 0.2402-0.6649) on the trigger day were significantly associated with low ORR. Receiver operator characteristic curve analyses revealed that serum E2 level/follicle (≥12 mm) had an area under the curve of 0.7036 (95 % CI 0.65-0.76; p < 0.01). The cut-off value was 169.2 pg/ml, with sensitivity of 65 % and specificity of 65 %, for predicting low ORR. Low ORR was associated with fewer top-quality embryos and more cycles with no embryos available for transfer. The rates of metaphase II oocytes, top-quality embryos, clinical pregnancy and live birth did not differ between the two groups.
Serum E2 level/follicle (≥12 mm) on the trigger day may be used as a predictive factor for low ORR in patients with PCOS. Low ORR may not affect oocyte and embryo developmental potential under appropriate ovarian stimulation management, but likely increases the risk of no embryos being available for transfer.
探讨多囊卵巢综合征（PCOS）患者体外受精（IVF）时低卵母细胞采集量的影响因素及后果。
本回顾性研究纳入了2017年1月至2022年12月期间720例行IVF的PCOS患者。卵母细胞采集率（ORR）定义为采集的卵母细胞数与扳机日直径≥12 mm卵泡数的比值。以平均ORR加减1个标准差作为界值，将患者分为低ORR组和正常ORR组。分析患者特征、促排卵方案、血清激素水平、卵母细胞成熟度、胚胎发育质量以及新鲜移植周期的妊娠结局。
ORR范围为0.06至2.69，平均值为1.02。与正常ORR组（ORR≥0.65）相比，低ORR组（ORR<0.65）患者体重指数更高；窦卵泡计数（AFC）更高；促性腺激素刺激天数更多；扳机日血清雌二醇（E2）水平更低、孕酮水平更低以及E2水平/卵泡（≥12 mm）更低。多因素逻辑回归分析显示，扳机日的AFC[调整优势比（aOR）1.05，95%置信区间（CI）1.0120 - 1.0940]、E2水平/卵泡（≥12 mm）（aOR 0.99，95% CI 0.9888 - 0.9972）和孕酮水平（aOR 0.41，95% CI 0.2402 - 0.6649）与低ORR显著相关。受试者工作特征曲线分析显示，血清E2水平/卵泡（≥12 mm）的曲线下面积为0.7036（95% CI 0.65 - 0.76；p<0.01）。预测低ORR的截断值为169.2 pg/ml，敏感性为65%，特异性为65%。低ORR与优质胚胎数量减少以及更多无胚胎可供移植的周期相关。两组间中期II级卵母细胞、优质胚胎、临床妊娠和活产率无差异。
扳机日血清E2水平/卵泡（≥12 mm）可作为PCOS患者低ORR的预测因素。在适当的卵巢刺激管理下，低ORR可能不影响卵母细胞和胚胎的发育潜能，但可能增加无胚胎可供移植的风险。
