81例非预期卵巢低反应病例特点及危险因素分析

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摘要目的分析卵巢储备功能正常患者在控制性卵巢刺激(COS)过程中出现非预期卵巢低反应的临床特征及危险因素。方法回顾分析2012年1月至2017年12月于北京大学第一医院妇产科生殖中心接受体外受精-胚胎移植(IVF-ET)、单精子卵胞浆内注射(ICSI)辅助生殖技术治疗的发生非预期卵巢低反应的卵巢储备功能正常患者,年龄<40岁,基础卵泡刺激素(FSH)<10 IU/L,双侧窦卵泡数(AFC) 7～20个。根据年龄、基础FSH、AFC、COS方案选择同期行IVF/ICSI的卵巢正常反应患者进行1∶1配对,非预期卵巢低反应组(病例组)及卵巢正常反应组(对照组)各81个周期,比较两组的临床资料、治疗经过及妊娠结局。结果病例组体重、体重指数、基础FSH／黄体生成素均高于对照组(P均<0.05)。病例组促性腺激素(Gn)使用天数、绒毛膜促性腺激素(hCG)日雌二醇(E₂)水平、hCG日孕酮水平、hCG日≥14 mm卵泡数低于对照组(P均<0.05),病例组hCG日孕酮卵泡比高于对照组(P<0.05)。病例组获卵数、MⅡ卵数、成胚数、优质胚胎数、可移植胚胎数及累积妊娠率均低于对照组(P均<0. 05)。条件Logistic回归分析显示,体重是发生卵巢非预期低反应的危险因素,基础LH是非预期卵巢低反应的保护因素。结论体重高、基础LH水平低的患者易发生非预期卵巢低反应,PFI值高、hCG日E₂低及≥14 mm卵泡数少提示低获卵数及妊娠率。在制定COS方案时应结合多项指标评价卵巢功能,制定个体化的治疗方案,指导患者减轻体重或许可以减少非预期卵巢低反应的发生。

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关键词 ：非预期卵巢低反应, 卵巢正常反应, 卵巢储备功能, BMI, 基础LH水平

Abstract：Objective To study the clinical characteristics and risk factors of unexpected poor ovarian response in patients with normal ovarian reserve in IVF / ICSI cycles.Methods This study was focused on infertile women who were diagnosed with poor ovarian response but normal ovarian reverse, with an age < 40 years, follicle-stimulating hormone (FSH) < 10 IU/L and antral follicle count 7-20. A retrospective study was performed among the patients in Peking University First Hospital reproductive center from January 2012 to December 2017. The 81 cycles that had less than or equal to 3 retrieved oocytes were defined as studied cases. Each case was matched with one control cycle by age, basal FSH level, AFC and protocol of controlled ovarian stimulation (COS) and time of therapy. We examined between-group differences in terms of the clinical characteristics (in hCG day), process of therapy and pregnant outcomes.Results The body weight, body mass index (BMI), basal FSH, and progesterone-to-follicle index (PFI) of case group were higher than that of control. Compared to the controls, the cases had a significantly lower level of gonadotropins days, estradiol, progesterone or counts of follicles ≥14 mm; and a significantly higher level of PFI. Additionally, cumulative pregnancy rate or number of retrieved oocytes, MII oocytes, embryos, high-quality embryos, or transplantable embryos was also significantly lower in cases than that in controls. Results of conditional logistic regression suggested that high BMI and low basal LH were risk factors of unexpected poor ovarian response.Conclusion High BMI and low basal LH increases the incidence of unexpected poor ovarian response. Higher PFI, lower estradiol, and smaller number of follicles ≥14 mm in the hCG day are associated with less retrieved oocytes and lower pregnancy rate. Individually specific COS need to be planned, according to evaluation of ovarian function. Losing weight may reduce the risk of unexpected poor ovarian response.

Key words： unexpected poor ovarian response normal ovarian response ovarian reverse BMI basal LH level

收稿日期: 2019-07-29

通讯作者: 薛晴(xueqingqq@hotmail.com)

引用本文:

席思思, 徐子衿, 徐阳, 尚鶄, 王宁, 薛晴. 81例非预期卵巢低反应病例特点及危险因素分析[J]. 中国生育健康杂志, 2020, 31(6): 529-534. Xi Sisi, Xu Zijin, Xu Yang, Shang Jing, Wang Ning, Xue Qing. Clinical characteristics and risk factors of unexpected poor ovarian response in 81 IVF / ICSI cycles. Chinese Journal of Reproductive Health, 2020, 31(6): 529-534.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2020/V31/I6/529

1 Vollenhoven B,Osianlis T,Catt J.Is there an ideal stimulation regimen for IVF for poor responders and does it change with age?.J Assist Reprod Genet,2008,25:523-529.
2 武学清,孔蕊,田莉,等.卵巢低反应专家共识.生殖与避孕,2015,35:71-79.
3 Ferraretti,AP,La Marca A,Fauser BC,et al.ESHRE consensus on the definition of ‘poor response′ to ovarian stimulation for in vitro fertilization:the Bologna criteria.Hum Reprod,2011,26:1616-1624.
4 胡琳莉,黄国宁,孙海翔,等.促排卵药物使用规范(2016).生殖医学杂志,2017,26:302-307.
5 席思思,杨慕坤,曾诚,等.减量降调长方案与拮抗剂方案在卵巢储备功能低下患者中的临床疗效观察.中国实用妇科与产科杂志,2018,34:559-562.
6 柯慧,颜礼征.博洛尼亚标准卵巢低反应者在促排卵体外受精/卵胞质内单精子注射周期中的卵巢反应性.中华生殖与避孕杂志,2018,38:5-10.
7 余照娟,郭培培,黄苗苗,等.不同年龄段患者基础FSH/LH比值对IVF/ICSI-ET临床结局的预测价值.安徽医科大学学报,2017,52:269-272.
8 LiuKE,Greenblatt EM.Elevated day 3 follicle-stimulating hormone/luteinizing hormone ratio^≥2 is associated with higher rates of cancellation in in vitro fertilization-embryo transfer cycles.Fertil Steril,2008,90:297-301.
9 Seckin B,Turkcapar F,Ozaksit G.Elevated day 3 FSH/LH ratio:a marker to predict IVF outcome in young and older women.J Assist Reprod Genet,2012,29:231-236.
10 Shrim A,Elizur SE,Seidman DS,et al.Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian response.Reprod Biomed Online,2006,12:418-422.
11 Noci I,Biagiotti R,Maggi M,et al.Low day 3 luteinizing hormone values are predictive of reduced response to ovarian stimulation.Hum Reprod,1999,14:863-864.
12 黄会霞,于医萍,冯艳奇,等.基础抗苗勒管激素在卵泡期长效促性腺激素释放激素激动剂长方案中对卵巢反应性及妊娠结局的预测价值.中华生殖与避孕杂志,2018,38:351-356.
13 Nardo LG,Gelbaya TA,Wilkinson H,et al.Circulating basal anti-Mullerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization.Fertil Steril,2009,92:1586-1593.
14 Zaidi S,Usmani A,Shokh IS,et al.Ovarian reserve and BMI between fertile and subfertile women.J Coll Physicians Surg Pak,2009,19:21-24.
15 Allegra A,Marino A,Volpes A,et al.A randomized controlled trial investigating the use of a predictive nomogram for the selection of the FSH starting dose in IVF/ICSI cycles.Reprod Biomed Online,2017,34:429-438.
16 陈艳,周爱莲.卵巢低反应者减量降调节并控制Gn启动剂量的体外受精结局.国际生殖健康/计划生育杂志,2018,37:28-31.
17 Shufaro Y,Sapir O,Oron G,et al.Progesterone-to-follicle index is better correlated with invitro fertilization cycle outcome than blood progesterone level.Fertil Steril,2015,103:669-674.e3.
18 Chen Y,Ma L,Wang S.The impact of an increased progesterone-to-follicle number ratio on live delivery rates in women with normal ovarian reserve.J Int Obstet Gynecol,2017,139:84-89.