Tholiya Shanti, Kumari Archana, Mahey Reeta, Kalaivani Mani, Sati Hem Chandra, Sharma Mona, Jayraj Aarthi K, Malhotra Neena
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
J Hum Reprod Sci. 2024 Oct-Dec;17(4):240-245. doi: 10.4103/jhrs.jhrs_133_24. Epub 2024 Dec 23.
Ovulation induction (OI) in patients with polycystic ovary syndrome (PCOS) remains challenging, and several biomarkers have been evaluated for their ability to predict ovulation. The predictive ability of candidate biomarkers, particularly with letrozole-based therapy in infertile PCOS women, remains inconclusive as it is yet to be evaluated in a prospective study.
To assess the role of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinising hormone (LH)/FSH ratio, testosterone and free androgen index (FAI) as predictors of ovarian response to letrozole-based OI therapy during OI cycles in infertile women with PCOS from North India.
A prospective cohort study was conducted in a tertiary care hospital in north India.
The study enrolled 80 infertile women with PCOS, diagnosed according to the Rotterdam criteria. OI was conducted using letrozole with or without human menopausal gonadotropin. Baseline endocrine and metabolic parameters, including serum AMH, FSH, LH, testosterone and FAI levels, were measured using ELISA or chemiluminescence methods on day 2 of the menstrual cycle. Follicular response to OI was monitored by transvaginal ultrasonography.
Descriptive and inferential statistical analyses were conducted, including Mann-Whitney, Kruskal-Wallis, Independent -test, analysis of variance, Fisher's exact test and receiver operating characteristic curve analysis. Data were processed using Microsoft Excel and analysed with SPSS software, version 25.0. < 0.05 was considered statistically significant.
Of 80 women enrolled, 74 responded to letrozole-based OI, while six were non-responders. Body mass index (BMI), serum testosterone and pre-treatment AMH levels significantly correlated with follicular response, with higher values linked to reduced responsiveness. The likelihood ratio+ (95% confidence interval) was 3.32 (2.45-5.06) for AMH, 1.97 (1.03-3.78) for BMI and 1.93 (1.22-3.08) for testosterone. The odds ratio for AMH was 2.88 (1.01-8.21) and 1.25 (1.02-1.53) for BMI. An AMH cut-off of ≤16.43 ng/mL predicted ovarian response with an AUC of 0.88.
Pre-treatment AMH levels, along with BMI and serum testosterone, are significant predictors of ovarian response to letrozole-based OI in infertile women with PCOS.
多囊卵巢综合征（PCOS）患者的促排卵治疗（OI）仍然具有挑战性，已经对几种生物标志物预测排卵的能力进行了评估。候选生物标志物的预测能力，特别是在不孕PCOS女性中基于来曲唑的治疗方面，仍然没有定论，因为尚未在前瞻性研究中进行评估。
评估抗苗勒管激素（AMH）、促卵泡生成素（FSH）、促黄体生成素（LH）/FSH比值、睾酮和游离雄激素指数（FAI）作为印度北部不孕PCOS女性在OI周期中对基于来曲唑的OI治疗卵巢反应预测指标的作用。
在印度北部的一家三级护理医院进行了一项前瞻性队列研究。
该研究纳入了80名根据鹿特丹标准诊断的不孕PCOS女性。使用来曲唑联合或不联合人绝经期促性腺激素进行OI。在月经周期第2天，采用ELISA或化学发光法测量包括血清AMH、FSH、LH、睾酮和FAI水平在内的基线内分泌和代谢参数。通过经阴道超声监测OI的卵泡反应。
进行了描述性和推断性统计分析，包括曼-惠特尼检验、克鲁斯卡尔-沃利斯检验、独立样本t检验、方差分析、费舍尔精确检验和受试者工作特征曲线分析。数据使用Microsoft Excel处理，并使用SPSS 25.0软件进行分析。P<0.05被认为具有统计学意义。
在纳入的80名女性中，74名对基于来曲唑的OI有反应，6名无反应。体重指数（BMI）、血清睾酮和治疗前AMH水平与卵泡反应显著相关，数值越高反应性越低。AMH的似然比+（95%置信区间）为3.32（2.45-5.06），BMI为1.97（1.03-3.78），睾酮为1.93（1.22-3.08）。AMH的比值比为2.88（1.01-8.21），BMI为1.25（1.02-1.53）。AMH截断值≤16.43 ng/mL预测卵巢反应的曲线下面积（AUC）为0.88。
治疗前AMH水平以及BMI和血清睾酮是不孕PCOS女性对基于来曲唑的OI卵巢反应的重要预测指标。
