Comparation The Value Of Common Indicators Used To Assesse Ovarian Reserve Function In Predicting Ovarian Response

Background and ObjectivesThe incidence of infertility is increasing as people's lifestyles and life philosophy change,social pressures increase,and environment getting worse day and day.The rapid development of assisted reproductive technology?ART?,in vitro fertilization and embryo transfer?IVF-ET?and its various derivative assisted reproductive technologies have helped many infertile couples to obtain offspring.The premise and key to the success of IVF-ET is to obtain enough mature and high-quality oocytes.Currently,the method of obtain oocytes is controlled ovarian stimulation?COS?.It is very important to make individualized controlled ovarian stimulation?iCOS?program according to the individualized characteristics of each IVF-ET pregnant woman to develope the live birth rate while reduce or even eliminate the risk of iatrogenic ovarian hyperstimulation syndrome.The iCOS protocol is based on the potential ovarian response of each individual infertile female.There are many clinical indicators for predicting ovarian response,but hasn't an independent indicator that can accurately reflect ovarian response.However,age and ovarian reserve function is closely related to ovarian response.Therefore,this study intends to study the best indicators for predicting ovarian response at each age group according to use age and the number of oocytes obtained to grouping.Materials and Methods1 Research objectSelect 1478 infertile women who received fertility treatment in the Department of Reproductive Medicine of the Second Affiliated Hospital of Zhengzhou University from August 2017 to December 2018,these women are eligible for inclusion.All of the 1478 infertile women are between the ages of 20⁴9?32.71±5.81?years,infertility period of 1²3?4.01±3.23?years.Reasons for infertility include female factors,male factors,both factors,immune factors and unknown causes.After the preoperative examination results showed no obvious abnormalities,these infertile women entered the ART treatment cycle,and adopted different superovulation strategies according to the individual characteristics of the patients.2 Grouping methodAccording to the age,1478 infertile women were divided into three groups:A?age?30 years old?,B?30 years old<age?35 years old?,C?age>35 years old?.In each group,there were divided into three subgroups based on the number of oocytes obtained,for example,number of oocytes obtained was<6,is low ovarian response group?A1,B1,C1?;number of oocytes obtained between6-18,is normalovarian response group?A2,B2,C2?;number of oocytes obtained was>18,is high ovarian response group?A3,B3,C3?.3 Specimen collection methodBasal follicle-stimulating hormone?bFSH?and basal estradiol?bE₂?were extracted from peripheral blood of menstrual 2⁴ sky abdomen and detected by electrochemiluminescence;anti-Muller tube peripheral blood was taken from the anti-Mullerian hormone?AMH?on an empty stomach and detected by enzyme-linked immunosorbent assay.Antral follicle count?AFC?measurement method:Follicles with a diameter of 2¹0 mm in both ovaries measured by transvaginal ultrasound in the early follicular phase.4 Statistical methodData processing was performed using SPSS22.0 statistical software.Measurement data were expressed as mean±standard deviation,and one-way analysis of variance was performed;age,bFSH,bE₂,AMH,AFC were used as test variables,and ovarian low response rate or ovarian high response rate(when counting ovarian low response group,The normal reaction group and the high reaction group were classified as non-low reaction groups,and the reaction group was used as the state variable,and the receiver operating characteristic curve?ROC?was drawn to calculate the area under the ROC curve?area under Curve,AUC?,ROC and Logistic regression analysis were used to evaluate the value of each indicator for predicting ovarian response alone or in combination.P<0.05 was considered statistically significant.Results?1?There were significant differences in serum bFSH,AMH,AFC and number of oocytes obtained between the three age groups?P<0.01?.With the increase of age,serum bFSH level gradually increased,serum AMH level gradually decreased,AFC and egg retrieval.The difference has statistically significant.There was no significant difference in serum bE₂ between the three groups?P>0.05?.?2?In the group of age?30 years old,with the increase of the number of oocytes obtained,AFC and serum AMH values gradually increased,serum bFSH values gradually decreased,and the differences were statistically significant?P<0.01?.The value of single index predicts ovarian low and high response is,AMH>bFSH>AFC>age,and the combination of multiple indicators does not significantly improve area under the curve?AUC?,predictive sensitivity,and specificity in the ROC predicting ovarian low and high response.?3?In the group of age between 30³5 years old,with the increase of the number of oocytes obtained,AFC and serum AMH values gradually increased,serum bFSH values gradually decreased,and the differences were statistically significant?P<0.01?.The value of single index predicts ovarian low and high response,AMH>AFC>bFSH>age,and multiple indicators can improve area under the curve?AUC?,predictive sensitivity,and specificity in the ROC predicting ovarian low response.But has not the same advantage in predicting ovarian high response.?4?In the group of age>35 years old,with the increase of the number of oocytes obtained,serum AMH values gradually increased?P<0.01?;age and serum bFSH of the ovarian low-response group were higher than those of the ovarian normal reaction group and the high-response group,the difference between three groups was statistically significant?P<0.01?;there was no significant difference in AFC between three groups?P>0.05?.The value of single index predicts ovarian low and high response is,AMH>bFSH>age>AFC,and multiple indicators can significantly improve area under the curve?AUC?,predictive sensitivity,and specificity both in predicting ovarian low and high response.Conclusions?1?Age is an important independent factor affecting ovarian reserve function and ovarian response;?2?When a single indicator predicts ovarian response,serum AMH is superior to AFC and serum bFSH;?3?For infertile women aged<30 years,serum AMH is a good predictor of ovarian response.serum bFSH,serum AMH,AFC combined,a combination of multiple indicators can not improve the value of predicting ovarian response;?4?For infertile women aged 30³5 years,a combination of multiple indicators can significantly improve the value of predicting ovarian low response,but has no significant advantage for predicting ovarian high response;?5?For infertile women>35 years old,age,serum bFSH,serum AMH combined,can significantly improve the sensitivity and specificity both of predicting ovarian low and high response.