基础窦状卵泡数结合年龄用于评估卵巢储备及预测卵巢低反应和体外受精临床结局

摘要

目的 选取基础窦状卵泡数(AFC)≤10个、年龄≥38岁初步作为界定卵巢储备减退的标准,研究在体外受精-胚胎移植(IVF-ET)治疗中通过AFC结合年龄评估卵巢储备、预测卵巢反应以及临床结局的价值.方法 回顾性队列研究2003年1月～2008年12月于我院行IVF-ET治疗的AFC≤10个的患者共1319周期.根据AFC数目进行分组,A组:AFC＜5个,B组AFC为5～7个,C组AFC为8～10个,同时按患者年龄分为＜38岁组和≥38岁组,比较各组患者的基本临床特征、获卵数及临床结局等的差异.结果 从A组至C组Gn使用量逐渐增大、可抽吸卵泡数和获卵数逐渐减少,其差异有显著性(P＜0.001).年龄＜38岁组Gn使用量显著大于≥38岁组,抽吸卵泡数和获卵数显著高于≥38岁组(P＜0.05).AFC≤7个且年龄＜38岁组卵泡数、获卵数少于AFC＞7个且年龄≥38岁组,Gn总量前者大于后者,临床妊娠率、分娩率前者高于后者.运用双变量相关分析以及多元线性回归分析获卵数与年龄及基础AFC、基础FSH的关系,得出AFC为卵巢反应性最佳单项预测指标.不同AFC组间患者临床妊娠率有显著性差异,早期自然流产率≥38岁组要明显高于年龄＜38岁组.结论 任何年龄妇女AFC≤7个或年龄≥38岁则AFC≤10个是卵巢储备降低较为合适的界定指标,若年龄＞40岁则AFC≤10个,出现卵巢低反应的几率高,AFC结合年龄是评估卵巢储备、预测卵巢反应性的最佳指标.年龄对于临床妊娠的预测价值,优于AFC.AFC主要影响卵子数量,而年龄主要影响卵子数量及质量.%Objective To study the value of basal antral follicle count (AFC) and age in predicting ovarian response and clinical outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods A total of 1319 oocyte retrieval cycles in women with an AFC<10 and complete FVF/ICSI cycles were analyzed retrospectively. According to the AFC, the patients were divided into groups A, B, and C with AFC<4, of 5-7, and of 8-10, respectively, and each was further divided into <38 years old group and >38 years old group. The oocytes retrieved, ovarian response, implantation rate, cancellations, pregnancy, pregnancy loss, and live births were evaluated. Results As the AFC increased, the total gonadotrophin (Gn) dose increased and the follicles aspirated and oocytes retrieved decreased significantly (PO.001). Patients below 38 years of age had a lower total Gn dose and more follicles aspirated and oocytes retrieved than older patients. An AFO7 and age>38 years was associated with significantly lower total Gn dose, greater number of follicles aspirated and oocytes retrieved, and lower pregnancy rate than an AFC<7 and age<38 years (P<0.05). Bivariate correlation and linear regression analysis identified AFC as the best single predictor of ovarian response in IVF. The pregnancy rate differed significantly between the 3 groups, and older patients (>38 years) had higher early miscarriage rate. Conclusion Antrol follicle count<7 or age>38 years old with AFC<10 is the suitable threshold of diminished ovarian reserve in controlled ovarian stimulation for infertile women. Combination of AFC and age is the best predictor of ovarian response in IVF. Age has a better predictive value of pregnancy rate than AFC. AFC influences mainly the oocytes quantity, while age also affects oocyte quality.