| Objective:1 The study is to identify and quantify these kinds of predictors of ovarian reserve through comparisons among the female age, the basal levels of the follicle stimulating hormone (FSH), luteinizing hormone (LH), estuarial (E2), the follicle stimulating hormone/luteinizing hormone ratio (FSH/LH) in serum, the basal levels of INH-B and AMH in serum and in follicular fluid, the levels of E2 on HCG admimistration day, gonadotropin doses and the total number of antral follicles counts(AFC)by ultrasound of women who had undergone IVF-ET. To select the better predictors to guide therapy in IVF.2 To study the effect of the outcome of IVF through comparisons among the number of oocytes retrieved, fertilization rate, cleavage rate, good embryo formation rate and pregnancy rate of women who had undergone IVF-ET.Methods:1 The study subject1.1 The poor response group: To select 20 patients with poor response who undergone IVF-ET because of infertility in the Second Hospital of HeBei Medical University from Mar 2007 to Dec 2007. Their mean ages were 31.46±2.79 years old. 1.2 The control group: To random select 20 patients with eumenorrhea who undergone IVF-ET because of infertility, from Mar 2007 to Dec 2007. The patients were tubal infertility and their elementary hormone FSH, LH, E2, PRL, T (MC: 3 day) were within normal limits. Their mean ages were 30.28±2.41 years old. All of the patients should be the first time to receive controlled ovarian hyper-stimulation (COH).2 Methods and Contents:2.1 Collecte the sample: All women receive controlled ovarian hyperstimulation (COH) and OC long down-regulated protocols, GnRH-a/Gonal-F/HMG/HCG. Serial LH, E2 levels and two-dimensional TVUS follicle measurements were performed until at least one dominant follicles reached at least 18-20mm or two dominant follicles reached at least 17mm or three dominant follicles reached at least 16mm in diameter. Then HCG 5000-10000iu was administered, followed by transvaginal oocyte retrieval 36h later. Follicular fluid uncontaminated by blood was selected. They was centrifuged at 2000r for 10min, (ordinary temperature), and the supernatant liquid were storaged at -20℃with refrigerator.2.2 Mensurate the sample: The levels of INH-B and AMH in serum and follicular fluid were tested by Enzyme linked Immunoabsorbent assay.2.3 Hormone assays: Baseline serum FSH, LH, E2, E2 at the day of HCG administered were all measured by CCES.2.4 Ultrasound measurement: The number of follicles smaller than 10mm in diameter in each woman was detected before the administration of gonadotropins by transvaginal ultrasound.Result:1 The levels of FSH, LH, E2, FSH/LH in serum were compared between the normal response group and the poor response group: The levels of FSH in serum were (6.41±1.78 mIU/ml vs 12.51±1.44 mIU/ml), the levels of LH in serum were (5.07±2.11mIU/ml vs 4.29±1.40mIU/ml), the levels of E2 were (45.71±20.92pg/ml vs 40.30±13.94pg/ml), the levels of FSH/LH were (1.46±0.57 vs 2.86±0.83). The levels of FSH, FSH/LH in serum were significantly different between the normal response group and the poor response group(P<0.05). The levels of LH, E2 in serum were not significantly different between the normal response group and the poor response group.2 The levels of INH-B in serum and follicular fluid were compared between the normal response group and the poor response group: The levels of INH-B in serum were (10.33±1.49pg/ml vs 8.53±1.07pg/ml), the levels of INH-B in follicular fluid were (9.86±2.10pg/ml vs 7.63±1.70pg/ml). They were significantly different between the normal response group and the poor response group(P<0.05).3 The levels of AMH in serum and follicular fluid were compared between the normal response group and the poor response group: The levels of AMH in serum were (41.88±10.18 ng/ml vs 29.20±6.09 ng/ml), the levels of AMH in follicular fluid were (37.58±8.17ng/ml vs 28.47±6.65ng/ml). They were significantly different between the normal response group and the poor response group(P<0.05).4 The female age and AFC were compared between the normal response group and the poor response group: The female age were not significantly different between the normal response group and the poor response group(30.28±2.41years vs 31.46±2.79years, P>0.05). AFC in the normal response group were higher than that in the poor response group (12.14±2.68 vs 4.85±1.68, p<0.01).5 The number of oocytes retrieved were (16.07±8.01 vs 4.61±1.52). The cleavage rate were (0.98±0.02 vs 0.79±0.31). They were significantly different between the normal response group and the poor response group(P<0.05). The fertilization rate, good embryo formation rate and pregnancy rate were not significantly different between the normal response group and the poor response group.6①The female age was correlated negatively with the level of AMH in serum and AFC (r=-0.424, P<0.05; r=-0.415, P<0.05).②The level of FSH was correlated negatively with the number of oocytes retrieved, the level of INH-B in serum and the level of AMH(r=-0.734, P < 0.05; r=-0.473, P < 0.05; r=-0.460, P<0.05).③The level of INH-B and AMH in serum were positively with the number of oocytes retrieved(r=0.622, P<0.05; r=0.465, P<0.05).7 To determine the value of predictors of ovarian response and IVF outcome.①The level of FSH in serum was the best independent predictor for the ovarian response. When all factors were considered, the AFC and the level of INH-B in serum have statistical significance as the predictors of ovarian response (p<0.05). AFC is a better predictor than the levels of INH-B in serum.②The level of AMH in serum was the best independent predictor for IVF outcome. When all factors were considered, the level of AMH in serum only has statistical significance as predictors for IVF outcome (p<0.05).Conclusion:1 As an independent predictor for the ovarian reserve, the level of serum FSH was the best predictor. When all factors were considered, AFC and the levels of INH-B in serum have statistical significance as predictors of ovarian reserve (p<0.05). AFC is a better predictor than the level INH-B in serum.2 As an independent predictor for the outcome of IVF, the level of AMH in serum was the best predictor. When all factors were considered, only the level of AMH in serum has statistical significance as predictors for the outcome of IVF(p<0.05). |
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