Study Of Predictors Of Clinic Markers Of Ovarian Response And IVF Outcome

Objective: The result of Controlled OvarianHyperstimulation (COH) results from ovarian response in invitro fertilization (IVF) .So it is important to accesses theovarian reserve. The study is to compare the basal levels of thefollicle stimulating hormone (FSH), luteinizing hormone (LH),the follicle stimulating hormone/ luteinizing hormone ratio(FSH/LH), estuarial (E2) in serum, the female age, the meanovarian volume and the total number of antral follicles byultrasound and the basal levels of INH-B in serum and infollicular fluid of the normal response group and the lowresponse group, the pregnant group and the nonpregnant groupwho had undergone IVF-ET. To identify and quantify thesekinds of predictors of ovarian response and the IVF outcome.Toselect the better predictors to guide therapy in IVF.Methods: Retrospective study forty-two women who hadundergone IVF-ET in the Second Hospital of Hebei MedicalUniversity from Mar 2004 to Oct 2004 because of fallopiantubal factor .The rage of the patients? age was 25-39 years. Thepatients who had undergone the first COH cycle are allocatedinto the normal response group (n=32) and the low responsegroup (n=10), the pregnant group (n=14) and the nonpregnantgroup (n=28). COH Protocol: Apply the COH long protocol:Gonadotropin Releasing Hormone (GnRHa) ﹑Gonadotropin(Gonal-F) ﹑Human Menopausal Gonadotropin (HMG) ﹑Human Chorionic Gonadotropin (HCG). Laboratory Analysis:(1)Hormone assay:The hormones including FSH,LH and E2 inthe serum were examined by CCES. (2) INH-B assay:TheINH-B levels in serum and follicular fluid were tested byEnzyme linked Immunoabsorbent assay. (3) Ultrasoundmeasurement:The mean oarian volume in each woman wasdetermined before entering IVF programe and the number offollicles smaller than 10 mm in diameter was detected before theadministration of gonadotropins by transvaginal ultrasound.Result: (1) The levels of FSH,LH,E2,FSH/LH in serumwere compared between the normal response group and the lowresponse group, the pregnant group and the nonpregnant group:1) The mean levels of FSH were significantly lower in thenormal response group (7.09±2.16 miu/ml) compared with thelow response group (9.87±2.64miu/ml, p<0.01). The levels ofFSH in the pregnant group were significantly different with thenonpregnant group (6.39±1.89miu/ml vs 8.44±2.58miu/ml,p<0.01). The levels of FSH in the pregnant group were lower.The levels of LH, E2, FSH/LH in serum were not significantlydifferent between the normal response group and the lowresponse group, the pregnant group and the nonpregnant group(P>0.05). 2) The levels of INH-B in serum and in follicular fluidwere compared between the normal response group and the lowresponse group, the pregnant group and the nonpregnant group.The levels of serum INH-B were significantly higher in thenormal response group compared with the low response group(31.70±4.6pg/ml vs 26.45±5.23pg/ml,p<0.01). The levels ofserum INH-B in the normal response group were higher. Thelevels of serum INH-B in the pregnant group were higher thanthat in the non-pregnant group. There were significantdifferences between them. (33.03±4.93pg/ml vs 29.15±4.93pg/ml,p<0.05); The levels of INH-B in follicular fluid in thenormal response group and in the pregnant group were higherthan that in the low response group (25.40±2.60pg/ml vs22.39±3.6pg/ml , p<0.01) and in the nonpregnant group(26.39±1.59pg/ml vs 23.83±3.34pg/ml,p<0.05);3) The femaleage, the mean ovarian volume and the total number of antralfollicles by ultrasound were compared between the normalresponse group and the low response group, the pregnant groupand the nonpregnant group. The female age in the normalresponse group and in the pregnant group was younger than thatin the low response group and in the nonpregnant grouprespectively, (31.03±3.54years vs 34.9±3.48 years,p<0.01;29.79±2.94 years vs 33.04±3.85 years,p<0.01). The meanovarian volume (6.06±2.55 ㎝~3) and the total number of antralfollicles(11.69±4.2) in the normal response group weresignificantly higher than these in the low response group(4.10±2.04cm~3,8.1±3.80; p<0.05). The mean ovarian volumein the pregnant group and in the nonpregnant group havesignificant difference (6.77±1.27㎝~3 vs 5.00±2.85㎝~3, p<0.05);The total number of antral follicles has no significant differencebetween the pregnant group and the nonpregnant group. 4)According to the levels of FSH, E2, and the mean ovarianvolume all patients are divided into two groups, the rates of thecollection of oocytes and pregnancy were compared respectively.According to the levels of FSH, all patients were divided intotwo groups,group A≥8.5 miu/ml group B<8.5 miu/ml.Therewere significant difference between them on the rate of thecollection of oocytes and pregnancy (p<0.05), The group B ishigher. According to the levels of E2, all patients were dividedinto two groups, group A E2≥80 pg/ml group B E2<80 pg/ml.There were significant differences between them on the rate ofthe collection of oocytes. The group A was higher than thegroup B.But they have no difference on the pregnancy rate.According to the mean ovarian volume, all patients weredivided into two groups,group A≥3 ㎝group B<3 ㎝.The 3 3group B was higher than the group A on the rate of thecollection of oocytes and pregnancy (p<0.05). 5) The levels ofserum FSH were correlated positively with the ratio of FSH/LHand the female age (r=0.447,p<0.01;r=0.33,p<0.05), the levelsof serum FSH was correlated negatively with the levels ofserum INH-B (r=-0.456,p<0.01), the levels of INH-B in serumwas correlated positively with that in follicular fluid, the totalnumber of antral follicles was correlated positively with themean ovarian volume (r=0.38,p<0.05). 6) To determine thevalue of predictors of ovarian response and IVF outcome. As anindependent predictor for the ovarian response, the result of ORof the basal levels of FSH, INH-B in serum and in follicularfluid, the female age, the total number of antral follicles and themean ovarian volume have statistical significance. As anindependent predictor the level of serum FSH was the bestpredictor. When all factors were considered, the female age andthe levels of INH-B in follicular fluid have statisticalsignificance as the predictors of ovarian response (p<0.05). Ageis a better predictor than the levels of INH-B in follicular fluid.As an independent predictor for the IVF outcome the result ofOR of the basal levels of FSH, INH-B in serum and in follicularfluid and the female age have statistical significance. The levelof INH-B in follicular fluid was the best independent predictor.When all factors were considered, the female age and the levelsof serum FSH and INH-B in follicular fluid have statisticalsignificance as predictors for IVF outcome (p< 0.05). The levelsof FSH in serum and INH-B in follicular fluid are betterpredictors than the female age.Conclusion: As an independent predictor for the ovarianreserve the level of serum FSH was the best predictor. When allfactors were considered, the female age and the levels of INH-Bin follicular fluid have statistical significance as predictors ofovarian reserve (p<0.05). Age is a better predictor than thelevels INH-B in follicular fluid. As an independent predictor forthe outcome of IVF, the level of INH-B in follicular fluid wasthe best predictor. When all factors were considered, the female...