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Objective:To explore the related factors of poor ovarian response (POR) in patients receiving controlled ovarian stimulation (COS) and to establish the nomogram for predicting POR in patients who received in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).Methods:In this retrospective research, clinical data of 17 164 cycles of patients who received IVF/ICSI treatment at Henan Provincial People′s Hospital from September 1st, 2016 to September 1st, 2020 were analyzed. Independent correlative factors affecting the occurrence of POR were screened by logistic regression, which were the model enrollment variables in the prediction model. Totally 13 266 cycles with well-record of enrollment variables were screened, and these data were randomly divided into model group (9 896 patients) and validation group (3 370 patients) according to 3∶1. The nomogram was established according to the regression coefficient of the relevant variables. The prediction accuracy of the nomogram was evaluated by calculating area under the receiver operating characteristic curve (AUC).Results:Multivariate logistic regression analysis showed age, infertility type, body mass index, anti-Müllerian hormone, basal follicle stimulating hormone, basal estrogen, antral follicle number, previous times of POR, history of ovarian surgery, ovulation stimulation protocol and average amount of gonadotropin were independent correlative factors affecting the occurrence of POR (all P<0.05). In the model group, according to the above factors, the prediction model and nomogram of POR risk were constructed and the validation group verified the model. The AUC of the model group was 0.893 (95% CI: 0.885-0.900), and the AUC of the validation group was 0.890 (95% CI: 0.878-0.903). Conclusion:The influencing factors of POR after COS in patients treated by IVF/ICSI are screened, and the nomogram for predicting POR established in this study is proved to be effective, simple, intuitive and clear in predicting the occurrence of POR.
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Objective:To observe the effect of modified Wuzi Yanzongwan periodic staging treatment on the outcome of assisted pregnancy in patients with poor ovarian response （POR） and kidney deficiency syndrome. Method:One hundred and four patients were randomly divided into observation group and control group， with 52 cases in each group. Both groups received gonadotropin releasing hormone （GnRH） antagonist regimen. The patients in control group additionally took Bushen Yutaiwan orally， 5 g/time， 3 times/day. The patients in observation group additionally took modified Wuzi Yanzongwan during pre-ovulation and post-ovulation periods， 1 dose/day. The treatment courses were 3 menstrual cycles （or termination after clinical pregnancy） in both groups. The number of eggs obtained， the number of available embryos， the number of fertilization， the number of high-quality embryos， the number of embryos implanted， the number of cycles cancelled， and the clinical pregnancy were recorded. Human chorionic gonadotropin （HCG） was injected， and then follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， estrogen （E<sub>2</sub>）， anti-Müllerian hormone （AMH）， basal antral follicle count （AFC） and endometrial thickness were measured daily. The number of days and dosage of Gn used， scores of kidney deficiency syndrome were recorded before and after treatment， and the adverse reactions during the study period were recorded. Result:The number of eggs captured， rate of harvested eggs， number of available embryos， rate of available embryos， number of high-quality embryos， rate of high-quality embryos， and fertilization rate in observation group were higher than those in control group （<italic>P</italic><0.05 or <italic>P</italic><0.01）. The cycle cancellation rate was lower than that in the control group； the embryo implantation rate and clinical pregnancy rate were superior than those in control group， but the difference was not statistically significant. The FSH level and FSH/LH ratio in observation group were lower than those in control group during HCG day （<italic>P</italic><0.01）， while E<sub>2</sub>， AMH， AFC and endometrial thickness were higher than those in control group （<italic>P</italic><0.01）. Simultaneously， the number of days and amount of Gn used in observation group was lower than that in control group （<italic>P</italic><0.01）. Conclusion:The Modified Wuzi Yanzongwan periodic staging treatment combined with GnRH antagonist scheme for patients with POR kidney deficiency syndrome， can regulate the level of endocrine hormones， promote follicular development， improve ovarian reserve， increase the number of eggs obtained， improve egg quality， help improve pregnancy outcomes， and increase the chances of successful pregnancy with assisted reproductive technology. It is worthy of further clinical research.
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Objective:To compare the effects of high progesterone induced ovulation (PPOs) and antagonist on the outcome of in vitro fertilization embryo transfer (IVF-ET) in patients with poor ovarian response (POR) .Methods:208 POR patients who underwent IVF-ET in our hospital were selected as the research objects, and were randomly divided into observation group and control group according to the random number table method, with 104 cases in each. The observation group were treated with PPOs regimen,while the control group were treated with antagonist regimen.The daily hormone levels of human chorionic gonadotropin (hCG) [follicle stimulating hormone (FSH) , luteinizing hormone (LH) , progesterone (P) , estradiol (E2) ], pregnancy outcome [total amount of gonadotropin (GN) , days of GN administration, number of oocytes retrieved, number of transferred embryos, cycle cancellation rate, oocyte maturation rate] and pregnancy outcomes were compared between the two groups (endometrial thickness on trigger day, number of transferred embryos, implantation rate, pregnancy rate, clinical pregnancy rate, abortion rate, live yield) .Results:The serum LH level in the observation group was significantly lower than that in the control group ( P<0.05) , and there was no difference in HCG hormone levels (FSH, P, E2) between the two groups after treatment ( P>0.05) . The total amount of Gn medication, Gn medication days, and oocyte maturation rate of the observation group after treatment were significantly higher than those of the control group, and the cycle cancellation rate was significantly lower than that of the control group ( P<0.05) ; The number of transferred embryos, embryo implantation rate, and live birth rate in the observation group after treatment were significantly higher than those in the control group, while the abortion rate was significantly lower than that in the control group ( P<0.05) ; There was no significant difference in the endometrial thickness and clinical pregnancy rate on trigger days between the two groups ( P>0.05) . Conclusions:Compared with the antagonist regimen, the PPOS regimen has a more obvious clinical effect in treatment of POR patients. It simplifies the process of ovulation stimulation and enhances the sensitivity of the ovaries to ovulation stimulation drugs. It is safe, convenient, economical and feasible, and is worthy of clinical promotion.
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Objective:To investigate the influence of age on the fresh cycle live birth rate in patients with poor ovarian response in different controlled ovarian hyperstimulation groups.Methods:The clinical data of 3 342 patients in The First Affiliated Hospital of Zhengzhou University from February 2014 to November 2018 were retrospectively collected, including early-follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long protocol group (1 375 cases), mid-luteal phase short-acting GnRH agonist long protocol group (1 161 cases) and GnRH antagonist protocol group (806 cases); each group was divided into 4 subgroups according to age: ≤30 years, 31－35 years, 36－40 years and >40 years, the pregnancy outcomes in each age subgroup were analyzed under different controlled ovarian hyperstimulation protocols.Results:In early-follicular phase long-acting GnRH agonist long protocol group, the final live birth rates of each age subgroup were 39.4% (228/579), 36.1% (135/374), 16.6% (48/290) and 3.0% (4/132); in mid-luteal phase short-acting GnRH agonist long protocol group, live birth rates of each age subgroup were 32.1% (99/308), 20.8% (55/264), 13.0% (45/346) and 7.0% (17/243); in GnRH antagonist protocol group, live birth rates of each age subgroup were 22.8% (26/114), 16.3% (25/153), 11.2% (31/278), and 3.8% (10/261); the live birth rate of each group decreased significantly with the increase of age (all P<0.01). When the age≤35 years old, the fresh cycle live birth rate of the early-follicular phase long-acting GnRH agonist long protocol group was significantly better than those of the other two groups (all P<0.01). The multivariate logistic regression analysis of age and live birth rate of the three controlled ovarian hyperstimulation groups showed age was the independent influence factor ( OR=0.898, 95% CI: 0.873-0.916, P<0.01; OR=0.926, 95% CI: 0.890-0.996, P<0.01; OR=0.901, 95% CI: 0.863-0.960, P<0.01). Conclusions:Age is an independent influencing factor for the prediction of fresh cycle live birth rate in low ovarian response patients. No matter which controlled ovarian hyperstimulation protocol is adopted, the final live birth rate decreases significantly with the increase of women′s age. In addition, the early-follicular phase long-acting GnRH agonist long protocol has the highest fresh cycle live birth rate among all controlled ovarian hyperstimulation groups.
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Background: Evaluation of the ovarian reserve is necessary to achieve an appropriate controlled ovarian stimulation (COS). This can be done by correctly predicting the ovarian response. The objective of this study was to derive a simple index by combining the above parameters which will be helpful determining ovarian response.Methods: This retrospective analysis was performed at Guru hospital, Madurai, involving 162 patients between July 2016 and July 2018. Inclusion criteria was all patients attending for their first ICSI (intracytoplasmic sperm injection) cycle between the above period, GnRH agonist protocol as the method of ovarian stimulation, no history of any previous ovarian surgery, presence of both ovaries and no evidence of any obvious endocrine disorders. We calculated MORPI values by multiplying the AMH (ng/ml) level by the number of antral follicles (2-9 mm), and the result was divided by the age (years) of the patient and the day- 3 serum FSH level.Results: At a cut-off value of 35 (AUC-0.952) for collection of ≥ 4 oocytes and 140 (AUC-0.952) for collection of ≥ 15 oocytes, MORPI was found to have optimum sensitivity and specificity under ROC curve analysis.Conclusions: MORPI is a simple, precise and cost effective index to predict a low ovarian response, the collection of >4 MII oocytes and an excessive ovarian response in infertile women. This index also has a good ability to predict the clinical pregnancy rate. This might be used to improve the cost-benefit ratio of ovarian stimulation regimens.
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Fallopian tube factors and decreased ovarian function are the main causes of female infertility. Decreased ovarian function includes premature ovarian failure, diminished ovarian reserve, premature ovarian insufficiency and poor ovarian response. The main feature of ovarian function decline is the decrease in the number and/or the low quality of ova, manifested as ovulation disorders, infertility and reproductive endocrine disorders. This article summarizes the progress in different evaluation criteria and treatment of decreased ovarian function, hoping to provide reference for future diagnosis and treatment.
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OBJECTIVE: To observe the clinical effect of acupuncture plus medication in the treatment of poor ovarian response (POR) patients and to explore its mechanisms in assisting pregnancy. METHODS: A total of 100 volunteer POR women undergoing in vitro fertilization-embryo transplantation (IVF-ET) were recruited in the present study. On the 1st cycle of IVF-ET, these POR women received microstimulation of ovulation program (oral administration of Clomiphene, muscular injection of Menotrophin, Chorionic Gonadotrophin triggering, etc.). Before receiving the 2nd period of IVF-ET, these patients were equally and randomly divided into control, medication (Climen, composed of estradiol valerate and cyproterone acetate), acupuncture and acupuncture+medication (combined treatment) groups according to the random number table. Patients of the medication group were asked to orally take Climen (1 tablet/d for 21 days) beginning from the 3rd day of the menstruation, which was repeated for 3 menstrual cycles. Patients of the acupuncture group received manual acupuncture stimulation of Guanyuan (CV4), and bilateral Taixi (KI3), Sanyinjiao (SP6) of and Tai-chong (LR3) from day 8 to 15 of menstruation (follicular phase), once daily for 3 menstrual cycles. On the 2nd day of menstruation of the 1st and 2nd IVF-ET cycle, the ovarian reserve function was detected, including measurement of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) contents by using radioimmunoassay, and serum anti-mullerian hormone (AMH) level by using ELISA, and the antral follicles count (AFC) of the ovaries by using a color Doppler ultrasonic diagnosis apparatus. At the end of ovulation induction, the assisted pregnancy indexes and outcomes were detected, including administration of dosage and days of gonadotropin (Gn), the diameter of dominant oocyte, level of E2 on the trigger day, the numbers of ultrasound-guided-retrieved oocyte and the cultivated high-quality embryo (grade 1 and 2). RESULTS: After the treatment, the contents of serum FSH, LH and E2 in the medication, acupuncture and combined treatment groups were significantly reduced (P0.05). CONCLUSION: Acupuncture combined with medication improves the level of endocrinal hormones and ovarian reservation function in POR women undergoing IVF-ET, benefiting the ovary environment of pregnancy.
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Objective:To evaluate the association between serum P,E2 and progesterone/estradiol ratio (P/E2) on pregnancy outcome in IVF/ICSI cycles with long agonist protocol.Methods:A review of complete data of 539 women underwent fresh IVF/ICSI cycles with long agonist protocol from January 2014 to February 2017 was done.Data were stratified into three groups according to the number of oocytes retrieved:low(≤4 oocytes obtained),intermediate (5-19 oocytes obtained),and high ovarian response (≥20 oocytes obtained) group.Receiver operating characteristics curve(ROC curve) analysis was performed to determine the cut-off value for P and P/E2 detrimental for pregnancy.Results:.With the increase of serum P level on daily hCG,the pregnancy rate was gradually decreased.The overall P level was 3.408 nmol/L,with the equivalent sensitivity and specifity were 55％,The P level of moderate and high responders was 3.408 nmol/L,with the equivalent sensitivity and specifity were 56％.Equivalent sensitivity and specificity of 62％ for P level of 4.042 nmol/L.The pregnancy rate (31.4％) in patients with P/E2 ≤0.49 was significantly higher than that in patients(23.4％) with P/E2 ＞0.49 (P=0.041),but there was no significant difference in fertilization rate and cleavage rate between them(P ＞ 0.05).Pregnancy rate,fertilization rate and cleavage rate at different E2 levels on daily hCG also had no statistical significance(P＞0.05).Conclusions:Level of serum P and P/E2 ratio on the day of human chorionic gonadotropin both are significant predictors for pregnancy outcome in IVF/ICSI cycles with long agonist protocol.
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The present study aimed to investigate the clinical value of serum anti-mullerian hormone (AMH) and inhibin B (INHB) in predicting the ovarian response of patients with polyeystic ovary syndrome (PCOS).A total of 120 PCOS patients were enrolled and divided into three groups in terms of the ovarian response:a low-response group (n=36),a normal-response group (n=44),and a high-response group (n=40).The serum AMH and INHB levels were measured by enzyme-linked immunosorbent assay (ELISA).The follicle stimulating hormone （FSH),luteinizing hormone (LH),and estradiol (E2) levels were determined by chemiluminescence microparticle immunoassay.The correlation of the serum AMH and INHB levels with other indicators was analyzed.A receiver operating characteristic (ROC) curve was established to analyze the prediction of ovarian response by AMH and INHB.The results showed that there were significant differences in age,body mass index (BMI),FSH,total gonadotropin-releasing hormone (GnRH),LH,E2,and antral follicle counts (AFCs) between the groups (P＜0.05).The serum AMH and INHB levels were increased significantly with the ovarian response of PCOS patients increasing (P＜0.05).The serum AMH and INHB levels were negatively correlated with the age,BMI,FSH level,Gn,and E2 levels (P＜0.05).They were positively correlated with the LH levels and AFCs (P＜0.05).ROC curve analysis of serum AMH and INHB in prediction of a low ovarian response showed that the area under the ROC curve (AUC) value of the serum AMH level was 0.817,with a cut-off value of 1.29 ng/mL.The sensitivity and specificity were 71.2％ and 79.6％,respectively.The AUC value of serum INHB was 0.674,with a cut-off value of 38.65 ng/mL,and the sensitivity and specificity were 50.7％ and 74.5％,respectively.ROC curve analysis showed when the serum AMH and INHB levels were used to predict a high ovarian response,the AUC value of the serum AMH level was 0.742,with a cut-off value of 2.84 ng/mL,and the sensitivity and specificity were 72.7％ and 65.9％,respectively;the AUC value of the serum INHB level was 0.551 with a cut-off of 45.76 ng/mL,and the sensitivity and specificity were 76.3％ and 40.2％,respectively.It was suggested the serum AMH and INHB levels have high clinical value in predicting the ovarian response of PCOS patients.
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Objective To comprae the difference of Sex hormone,serum and follicular fluid anti Mullerian hormone (AMH) level tube,number of retrieved egg,the number of cleavage rate,fertilization oocytes,the number of available embryos and total embryo on in vitro fertilization and embryo transfer (IVF-ET) of different reaction groups,to explore the relationship between AMH and pregnancy outcome of IVF-EH.Methods Eighty-one cases of IVF-ET assisted pregnancy were divided into low ovarian response group,normal ovarian response group and high ovarian response group according to the response of the super ovulation.Serum sex hormone and AMH of all patients were detected on the third day of menstruation,on the day of HCG injection,oocyte pick-up (OPU) and embryo transfer (ET),AMH in FF were detected too.The difference of oocytes,cleavage rate,embryo quality and the indicators mentioned above among the three groups were compared.All of the above indicators were compared between pregnancy group and unpregnancy group.Results (1) The level of AMH on the third day of menstruation ((1.76 ± 0.47) μg/L,(3.45 ± 1.01) μg/L,(6.34 ± 1.29) μg/L,F =2.435,P＜0.001),HCG injection ((1.09±0.13)μg/L,(1.29±0.29)μg/L,(2.64±0.51)μg/L,F=1.542,P=0.001) and embryo planting((1.32±0.33) μg/L,(1.62±0.39) μg/L,(1o 91±0.41) μg/L,F =1.573,P ＜0.001) all were statistically significant in three groups.On day of OPU,the levels of serum AMH ((0.95±0.21)μg/L,(1.15±0.29) μg/L,(1.74±0.41) μg/L,F =12.573,P＜0.001) and AMH in FF((5.82±1.19) μg/L,(6.92±1.05) μg/L,(7.79±1.39) μg/L,F =9.83,P＜0.001) were statistically differences in the three groups.(2)The number of oocytes were positively correlated with AFC,based AMH,levels of E2,P and AMH on the day of HCG injection and OPU,E2 and AMH on the day of ET and AMH in FF(P＜0.05).(3)AMH in FF in pregnancy group was (6.22±0.82)μ g/L,significantly higher than those without pregnancy group ((5.31 ±0.71)μg/L,P =0.037).Conclusions Levels of AMH in serum and follicular fluid are good predictors of ovarian response in IVF-ET.The level of serum AMH can only predict ovarian response,but can not effectively predict pregnancy outcome.The level of AMH in FF is a good predictor of pregnancy outcome.
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Objective: To investigate the clinical outcome of ovulation induction in patients with poor ovarian response treated with in vitro fertilization. Methods: A total of 120 patients with poor ovarian response in our hospital from Nov 2013 to Oct 2015 were en?rolled and were divided into 3 groups according to the different treatment methods. The clinical outcome were compared. Results:There was no significant difference in fertilization rate, cleavage rate, available embryo rate, good embryo rate and pregnancy rate in 3 groups ( P>0?05) . The time and doses of gonadotropin in minimal ovarian stimulation group were significantly lower than those in antagonist protocol group and luteal?phase ovulation induction group ( P<0?05) . The embryo freezing rate in minimal ovarian stimula?tion group was significantly higher than that in antagonist protocol group ( P<0?05 ) . The number of oocytes in antagonist protocol group was significantly higher than those in minimal ovarian stimulation group and luteal?phase ovulation induction group, and the em?bryo transplantation cancellation rate was lower than those in minimal ovarian stimulation group and luteal?phase ovulation induction group ( P<0?05) . Conclusion: Minimal ovarian stimulation method has good curative effect, and more suitable for the treatment of poor ovarian response.
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Ovarian stimulation with commercial preparations of equine chorionic gonadotropin (eCG) produces extremely variable responses in domestic animals, ranging from excessive stimulation to practically no stimulation, when applied on the basis of their declared unitage. This study was conducted to analyze four commercial preparations from different manufacturers via reversed-phase HPLC (RP-HPLC) in comparison with a reference preparation and an official International Standard from the World Health Organization. The peaks obtained by this qualitative and quantitative physical–chemical analysis were compared using an in vivo bioassay based on the ovarian weight gain of prepubertal female rats. The RP-HPLC data showed one or two peaks close to a main peak (t(R) = 27.9 min), which were related to the in vivo bioactivity. Commercial preparations that have this altered peak showed very little or no in vivo activity, as demonstrated by rat ovarian weight and in peripubertal gilts induced to ovulate. Overall, these findings indicate that RP-HPLC can be a rapid and reliable tool to reveal changes in the physicochemical profile of commercial eCG that is apparently related to decreased biological activity of this hormone.
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Animals , Female , Humans , Rats , Animals, Domestic , Biological Assay , Chorion , Chorionic Gonadotropin , Chromatography, High Pressure Liquid , Electrocardiography , Ovulation Induction , Weight Gain , World Health OrganizationABSTRACT
PURPOSE: This study attempted to derive an objective and sophisticated definition of poor ovarian response (POR). MATERIALS AND METHODS: A total of 176 consecutive in vitro fertilization (IVF) cycles (137 patients) with conventional ovarian stimulation during 2009 to 2012 were studied by retrospective analysis. Optimal oocyte number (total or mature) was determined by statistics-based (distribution of oocyte number) and prognosis-based approaches (prediction for IVF outcome). Receiver operating characteristics curve analysis was used to show what number of oocytes could predict IVF pregnancy and whether clinical and laboratory variables could predict newly defined POR. RESULTS: The 25th percentile of the distribution corresponded to total oocytes 5 and mature oocyte >1. Considering the incidence of POR (34.1%), a reasonable definition of POR was decided as total oocytes < or =2 or mature oocyte < or =1. For the prediction of this new definition, the extreme cut-off value (by setting a false positive rate of 5%) of serum anti-Mullerian hormone (AMH) was < or =0.76 ng/mL, which was better than serum follicle stimulating hormone or age. A new simple definition of POR was derived as total oocytes < or =2 or mature oocyte < or =1 in a previous cycle or a serum AMH level of < or =0.76 ng/mL. When this simple criterion was re-applied to our data, the predictive performance was similar to the Bologna criteria. CONCLUSION: We here propose a new definition of POR, which is simple and supported by statistical and prognostic analyses.
Subject(s)
Adult , Female , Humans , Pregnancy , Anti-Mullerian Hormone/blood , Fertilization in Vitro , Follicle Stimulating Hormone/blood , Infertility, Female/blood , Oocytes , Ovulation Induction , Prognosis , ROC Curve , Retrospective Studies , Sperm Injections, Intracytoplasmic , Treatment OutcomeABSTRACT
PURPOSE: This study attempted to derive an objective and sophisticated definition of poor ovarian response (POR). MATERIALS AND METHODS: A total of 176 consecutive in vitro fertilization (IVF) cycles (137 patients) with conventional ovarian stimulation during 2009 to 2012 were studied by retrospective analysis. Optimal oocyte number (total or mature) was determined by statistics-based (distribution of oocyte number) and prognosis-based approaches (prediction for IVF outcome). Receiver operating characteristics curve analysis was used to show what number of oocytes could predict IVF pregnancy and whether clinical and laboratory variables could predict newly defined POR. RESULTS: The 25th percentile of the distribution corresponded to total oocytes 5 and mature oocyte >1. Considering the incidence of POR (34.1%), a reasonable definition of POR was decided as total oocytes < or =2 or mature oocyte < or =1. For the prediction of this new definition, the extreme cut-off value (by setting a false positive rate of 5%) of serum anti-Mullerian hormone (AMH) was < or =0.76 ng/mL, which was better than serum follicle stimulating hormone or age. A new simple definition of POR was derived as total oocytes < or =2 or mature oocyte < or =1 in a previous cycle or a serum AMH level of < or =0.76 ng/mL. When this simple criterion was re-applied to our data, the predictive performance was similar to the Bologna criteria. CONCLUSION: We here propose a new definition of POR, which is simple and supported by statistical and prognostic analyses.
Subject(s)
Adult , Female , Humans , Pregnancy , Anti-Mullerian Hormone/blood , Fertilization in Vitro , Follicle Stimulating Hormone/blood , Infertility, Female/blood , Oocytes , Ovulation Induction , Prognosis , ROC Curve , Retrospective Studies , Sperm Injections, Intracytoplasmic , Treatment OutcomeABSTRACT
OBJECTIVE: In 2009 anti-Mullerian hormone (AMH) assay was approved for clinical use in Korea. This study was performed to determine the reference values of AMH for predicting ovarian response to controlled ovarian hyperstimulation (COH) using the clinical assay data. METHODS: One hundred sixty-two women who underwent COH cycles were included in this study. We collected data on age, basal AMH and FSH levels, total dose of gonadotropins, stimulation duration, and numbers of oocytes retrieved and fertilized. Blood samples were obtained on cycle day 3 before gonadotropin administration started. Serum AMH levels were measured at a centralized clinical laboratory center. The correlation between the AMH level and COH outcomes and cut-off values for poor and high response after COH was analyzed. RESULTS: Concentration of AMH was significantly correlated with the number of oocytes retrieved (OPU; r=0.700, p or =20) response were 0.94+/-0.15 ng/mL, 2.79+/-0.21 ng/mL, and 6.94+/-0.90 ng/mL, respectively. The cut-off level, sensitivity and specificity for poor and high response were 1.08 ng/mL, 85.8%, and 78.6%; and 3.57 ng/mL, 94.4%, and 83.3%, respectively. CONCLUSION: Our data present clinical reference values of the serum AMH level for ovarian response in Korean women. The serum AMH level could be a clinically useful predictor of ovarian response to COH.
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Female , Humans , Anti-Mullerian Hormone , Gonadotropins , Korea , Oocytes , Reference Values , Sensitivity and SpecificityABSTRACT
OBJECTIVE: The aim of this study was to investigate whether anti-Mullerian hormone (AMH) levels could be predict ovarian poor/hyper response and IVF cycle outcome. METHODS: Between May 2010 and January 2011, serum AMH levels were evaluated with retrospective analysis. Three hundred seventy infertile women undergoing 461 IVF cycles between the ages of 20 and 42 were studied. We defined the poor response as the number of oocytes retrieved was equal or less than 3, and the hyper response as more than 25 oocytes retrieved. Serum AMH was measured by commercial enzyme-linked immunoassay. RESULTS: The number of oocytes retrieved was more correlated with the serum AMH level (r=0.781, p3.55 ng/mL), the groups showed no statistical differences in mature oocyte rates (71.6% vs. 76.5% vs. 74.8%) or fertilization rates (76.9% vs. 76.6% vs. 73.8%), but showed significant differences in clinical pregnancy rates (21.7% vs. 24.1% vs. 40.8%, p=0.017). CONCLUSION: The serum AMH level can be used to predict the number of oocytes retrieved in patients, distinguishing poor and high responders.
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Female , Humans , Anti-Mullerian Hormone , Fertilization , Fertilization in Vitro , Oocytes , Pregnancy Rate , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Exogenous gonadotropins are widely used in controlled ovarian stimulation (COH) for patients undergoing in-vitro fertilization (IVF),because of the effect of follicle maturation and ovulation.Except for environmental factors such as age and ovarian reserve,genetic variability seems also to be a key factor in determining the ovarian response to the exogenous gonadotropins.In this review, the reason for the interindividual difference in ovarian resoponse as well as the influence of the genetic polymorphisms of FSHR and ESR on COH and IVF outcome has been summarized.
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Objective To investigate the level of follicular fluid NO, VEGF and ET-1 in assessing IVF-ET outcome. Methods Totally 131 patients undergoing IVF-ET cycles were recruited. The level of follicular fluid NO was measured by chromatometry. The follicular fluid VEGF and ET-1 were measured by ELISA. Transvaginal ultrasound was performed on human chorionic gonadotropin (hCG) injection day to determine ovarian volume and antral follicle count. Results The pregnancy rate was 37.40% (49/131). There were significantly increased level of follicular fluid NO, VEGF and decreased level of follicular fluid ET-1 in the pregnant group than those in the non-pregnant group (P<0.05). Total ovarian volume and antral follicle count on HCG injection day were significantly higher in the pregnant group than those in the non-pregnant group (P<0.05). The levels of follicular fluid NO and VEGF had positive correlations with the total ovarian volume and antral follicle count. However, the level of follicular fluid ET-1 had a negative correlation with the total ovarian volume and antral follicle count. Conclusions The high level of NO, VEGF and low level of ET-1 in follicular fluid are good predictors of ovarian blood flow and ovarian response in IVF-ET.
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Objective To sequence follicle stimulating hormone receptro (FSHR) promoter of the ovarian granulocyte and initially research the molecular mechanism of the poor ovarian response. Methods To study the relationship between FSHR promoter mutation of ovarian granulocyte and ovarian respone. The 263 bp DNA fragments before FSHR 5'initiation site in 70 cases of patients with poor ovarian respone and 88 cases of patients with ovarian normal respone who were in the cycle of IVF-ET were sequenced, Results There were 63 cases which occurred 29th site G → A point mutation in 158 women and the mutation rate was 40. 0%. Mutation rate [ 60. 0% ( 42/70 ) ] of 29th site G → A in group of poor ovarian respone was significantly higher(χ2 = 21. 450,P < 0. 01 ) than normal response group [ 23.9% ( 21/88 ) ]. There was no obviously variability ( t = 0. 457, P 0. 05 ) of basic FSH values between two groups [ G/G group was (7.2 ± 2. 3) U/L, G/A & A/A group was (7. 1±2. 0) U/L];there was obviously variability (t = 35. 81 ,P < 0. 05 ) in the number of follicles sinus between two groups ( G/G group was 14. 2±1.3, G/A & A/A group was 4. 5±0. 8 ) ;there was obviously variability ( t = 40. 35, P < 0. 05 ) in the number of ovum pick-up between two groups ( G/G group was 14. 0±1.2, G/A & A/A group was 4. 5±1.1 ) ;there was obviously variability (t =25. 80,P <0.05) of FE2-peak value between two groups [G/G group was (2 865±557) pmol/L, G/A & A/A group was (880±211 ) pmol/L] ;there was obviously variability (t =40. 22 ,P <0. 05) in the number of mature eggs ( G/G group was 13.6±1.2, G/A&A/Agroupwas4.3±0. 9).Conclusion The 29th site of FSHR promoter significantly affect the activity of FSHR promoter. Mutation of G→A can weaken promoter activity, so that ovarian granulocyte poor respone to FSH.
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Objective To investigate relationship between levels of follicle-sitimulating horomone receptor(FSHR) and ovarian response induced by gonadotropin hormone,and whether the FSHR expression is correlated with in vitro fertilization(IVF) outcome.Methods Granulose cells were collected from 43 women receiving IVF-embryo transplantation(IVF-ET).According to the number of oocyte,the women were divided into three groups: low response(15).The expression intensity of FSHR was measured by immunohistochemistry technique.The expression intensity of FSHR on the granular cell,the embryological and clinical outcomes were compared and analyzed. Results The expression of FSHR was significantly different in three groups with the highest in high response group(P0.05).The FSHR level was positively correlated either with the number of oocyte (r=0.719) or with the serum E2 levels(r=0.516,P0.05). Conclusion Ovarian response to gonadotropin hormone stimulation is correlated with the level of FSHR in the granulose cells.The development of follicles may be influenced by it.