| ObjectiveThe aim of this study is to measure three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) indices by 3D-US and PDA on the day of pituitary suppression control, identify these kinds of predictors of ovarian response and the IVF outcome through comparisons among the antral follicle counts(AFC),the mean ovarian volume(MOV) and vascularisation index (Ⅵ),flow index (FI)and vascularisation flow index (VFI), Combined with the female age, the basal levels of the follicle stimulating hormone(FSH), the follicle stimulating hormone/luteinizing hormone ratio(FSH/LH), estradiol(E2) in serum, the serum follicle stimulating hormone concentrations following the Pituitary suppression cycle, evaluate whether these measurements can predict ovarian reserve. to select the better predictors to guide therapy. by analysis the correlation between 3D-power doppler ultrasound and each prediction index, to explore ultrasonic indicators and each clinical index internal relations and better guide clinical comprehensive judgments ovarian reserve function, formulate rational scheme and increase pregnancy rate in IVF-ET. MethodsRetrospective study included two hundred and thirty-eight women who had undergone IVF-ET/ICSI-ET in the reproductive medicine center of the first affiliated hospital of Zhengzhou university from Oct 2010 to Jan 2011. The range of the patients age was 21-43 years. They have regular menstrual cycles and had undergone the first COH cycle. They had been infertile between 1 and 14 years. The causes of infertility included fallopian tubal factor male factor,mixed factor and unexplained infertility.Laboratory Analysis:①The hormones including FSH, LH and E2 of cycle day 2-3 serums sample were measured by ECLIA.②ECLIA measured the basal follicle stimulating hormone concentrations following the pituitary suppression cycle before the administration of gonadotropins.③Transvaginal ultrasound measurement: using 3D ultrasound Sono automatic volume calculation (AVC) and a 3D-power Doppler volume histogram. Sono AVC was used to automatically measure the number and volume of follicles. The volume histogram was used to measure the vascularization index (Ⅵ),flow index (FI) and vascularization flow index in the ovaries before the administration of gonadotropins.Results1. comparison each indexes of the ovarian response normal group and the poor ovarian response group(1) 3D- power doppler index predictive the ovarian response:①AFC were significantly different between the normal response group and the low response group(12.41±4.77 vs 4.90±1.59, P<0.05).②MOV following the Pituitary suppression cycle were significantly different between the normal response group and the low response group(5.51±2.39 vs 2.87±0.08cm3, P<0.05).③FI were significantly different between the normal response group and the low response group(30.01±5.77 vs 26.79±2.15, P<0.05).④VI and VFI following the Pituitary suppression cycle were no significantly different between the normal response group and the low response group (P>0.05). (2) Sex hormones and age predictive the ovarian response:①The levels of FSH were significantly different between the normal response group and the low response group(6.64±1.72mIU/mL vs 8.95±2.33mIU/mL, P<0.05).②The female age was no significantly different between the normal response group and the low response group(31.60±4.70years vs 32.80±4.67years, P>0.05).③The levels of FSH/LH and E2 were no significantly different between the normal response group and the low response group(P>0.05).④The FSH and levels of FSH/LH concentrations following the Pituitary suppression cycle were no significantly different between the normal response group and the low response group (P>0.05).2. Compare toeach index Pregnancy group and no pregnancy group(1) 3D- power doppler index predictive the Pregnancy outcome:①The AFC following the pituitary suppression cycle by 3D-US were significantly different between the pregnant group and the nonpregnant group((13.97±2.75 vs 7.77±1.89, P<0.05), The area under the ROC curves which AFC predict the pregnancy outcome is 0.740 (P<0.05).②The MOV following the pituitary suppression cycle were no significantly different between the pregnant group and the nonpregnant group (.P>0.05).③The VI,FI,VFI following the pituitary suppression cycle by 3D-US and PDA were no significantly different between the pregnant group and the nonpregnant group(P>0.05).(2) Sex hormones and age predictive the Pregnancy outcome:①The levels of FSH in serum was significantly different between the pregnant group and the nonpregnant group(7.62±1.51mIU/mL vs 8.43±2.93mIU/mL, P<0.05).②The femalc age was not significantly different between the pregnant group and the nonpregnant group(32.09±4.68years vs 32.09±4.63years, P>0.05).③The levels of E2 and FSH/LH in serum were not significantly different between the pregnant group and the nonpregnant group (P>0.05).④The serum FSH,FSH/LH concentrations following the pituitary suppression cycle were no significantly different between the Pregnant group and the nonpregnant group (P>0.05).3. the correlation between 3D-power doppler ultrasound and each prediction index①AFC was correlated negatively with basal serum FSH and the female age (r=-0.565, P<0.01; r=-0.427, P<0.01, respectively), and was positively correlated with MOV (r=0.789, P<0.001).②MOVwas correlated negatively with basal serum FSH and the female age (r=-0.358, P<0.01; r=-0.264, P<0.05, respectively)③FI was correlated negatively with basal serum FSH(r=-0.539, P<0.01), and correlated positively with AFC(r=0.636,P<0.01).4. The related regression analysis egg number and the indexes of ovarian reserves①the number of oocytes retrieved and the clinical pregnaney rate of the normal response group was significantly more than that the low response group(13.33±6.72 vs 3.5±1.94, P<0.01; 54.69% vs 30.30%, P<0.01, respectively).②To determine the value of predictors of ovarian reserve. The multiple line regression analysis showed the FSH,AFC,MOV and FI that had statistical significance as the number of oocytes retrieved, which regression coefficients respectively is -0.272,1200,1.734 and 0.210 (P<0.01).5. Compare to number of oocytes retrieved,fertilization rate and good embryo rate with different pregnancy outcome①the number of oocytes retrieved and the fertilization rate between the pregnant group and the nonpregnant group had significant difference(11.17±3.71 vs 10.87±5.98, P<0.01; 86.67% vs 71.73%,P<0.01, respectively).②the good embryo rate between the pregnant group and the nonpregnant group had no significant difference(P>0.05).Conclusions(1) the number of antral follicles on the day of pituitary suppression control are the only independent predictors of the ovarian reserve function. AFC is the best predictive index of the ovarian responseand when AFC>9, IVF-ET pregnancy rate is higher.3D-US and PDA are appropriate methods for a Accurately comprehensive assessment of the ovarian reserve function.(2) 3D-US and PDA measure the ovarian volume on the day of pituitary suppression control more accurate and more quickly, and can reflect the basic condition of the ovarian, which is appropriate methods for the assessment of the ovarian response.(3) After the pituitary suppression control, The FI of the ovary are also significantly related to ovarian response,3D-US and PDA are appropriate methods for a fast, easy, noninvasive, no radiation and one-step assessment of all the stromal blood flow of the ovarian(5) 3D-US and PDA indicators are negatively correlated with age based FSH Speculated that age and basic FSH may be affect ovarian reserve function by affected the ovary blood flow. Comprehensive account of various clinical indicators can better evaluate ovarian reserve function. |
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