Avrech O M, Royburt M, Sabah G, Zukerman Z, Pinkas H, Amit S, Ovadia J, Fisch B
Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah Tikva, Israel.
J Assist Reprod Genet. 1996 May;13(5):395-400. doi: 10.1007/BF02066171.
Our purpose was to assess the potential role of the baseline hormone profile in combination with the initial pattern of response to gonadotropin releasing hormone (GnRH) analogue in predicting ovarian function and hence reproductive outcome in normogonadotropic patients aged 40 years or older undergoing IVF treatment.
A retrospective analysis of 394 controlled ovarian hyperstimulation (COH) cycles that reached the stage of oocyte retrieval was conducted. The study included 163 normogonadotropic (serum FSH < or = 15 IUIL) patients aged between 40 and 48 years who had regular menstrual cycles. Superovulation was achieved using menotropins in combination with GnRH analog (short protocol, beginning on menstrual day 2). The ovarian response was monitored on the third cycle day, the day following the first GnRH analogue administration.
Cycle distribution by patient age was 175 (44.4%), 122 (30.9%), and 97 (24.7%), while the patient distribution was 85 (52.2%), 48 (29.5%), and 30 (18.3%) for age groups 40-41, 42-43, and 44-48 years, respectively. The mean total dose of menotropins needed for optimal COH was 1787 IU (range, 600-6000 IU). This dose increased with age, while the yield of oocytes and embryos declined (P < 0.05; ANOVA). A positive correlation was demonstrated between the E2 level on day 3 (GnRH analogue flare effect) and the outcome of the treatment cycle (number of oocytes and embryos). Using multiple stepwise regression analysis, it was demonstrated that the initial (day 3) serum E2 levels, combined with baseline FSH levels, patients's age and body mass index enabled early prediction of the ovarian response in the current IVF-ET treatment cycle (oocytes = 8.2 - 0.18 x Age + 0.17 x BMI - 0.12 x FSH + 0.0042 x E2).
Multiple-parameter analysis demonstrated that the use of the initial E2 response to GnRH analogue stimulation combined with basic clinical data may assist in the prediction of ovarian function and hence the reproductive outcome in normogonadotropic IVF patients aged 40 years or older. This may serve as a clinical tool for improving patient selection and treatment outcome in IVF-ET.
我们的目的是评估基线激素水平结合促性腺激素释放激素（GnRH）类似物初始反应模式在预测40岁及以上接受体外受精（IVF）治疗的正常促性腺激素患者卵巢功能及生殖结局方面的潜在作用。
对394个达到取卵阶段的控制性卵巢刺激（COH）周期进行回顾性分析。该研究纳入了163例年龄在40至48岁之间、月经周期规律的正常促性腺激素（血清促卵泡激素[FSH]≤15IU/L）患者。使用促卵泡素联合GnRH类似物（短方案，月经周期第2天开始）进行超排卵。在第3个周期日，即首次给予GnRH类似物后的次日，监测卵巢反应。
按患者年龄划分的周期分布为175个（44.4%）、122个（30.9%）和97个（24.7%），而年龄组40 - 41岁、42 - 43岁和44 - 48岁的患者分布分别为85例（52.2%）、48例（29.5%）和30例（18.3%）。最佳COH所需促卵泡素的平均总剂量为1787IU（范围600 - 6000IU）。该剂量随年龄增加，而卵母细胞和胚胎产量下降（P<0.05；方差分析）。第3天（GnRH类似物激发效应）的雌二醇（E2）水平与治疗周期结局（卵母细胞和胚胎数量）之间呈正相关。通过多元逐步回归分析表明，初始（第3天）血清E2水平，结合基线FSH水平、患者年龄和体重指数能够早期预测当前IVF - 胚胎移植（ET）治疗周期的卵巢反应（卵母细胞数 = 8.2 - 0.18×年龄 + 0.17×体重指数 - 0.12×FSH + 0.0042×E2）。
多参数分析表明，使用GnRH类似物刺激后的初始E2反应结合基本临床数据，可能有助于预测40岁及以上正常促性腺激素IVF患者的卵巢功能及生殖结局。这可作为一种临床工具，用于改善IVF - ET患者的选择和治疗结局。
