| BackgroundWith the rapid development of reproductive medicine, assisted reproductive technology has been widely used in the treatment of infertility, but the curative effect of IVF-ET is far from ideal expectations. In a number of factors determining the success of IVF-ET, assessing ovarian reserve function accurately occupies the important position. There are many factors that currently used to assess ovarian reserve function, with age and basal FSH are the two important predictors to predict ovarian response. For many young women, though its basal FSH levels were normal but the number of follicle and egg developing to the mature stage is still lower in the process of promoting ovulation and it is likely to occur follicle atresia and egg quality decline, ovarian function failure,. How to assess ovarian reserve effectively and accurately is still a problem for those people.In recent years, ultrasonic technology, with its simple, noninvasive, rapid and accurate advantages gradually be applied to clinical.,especially the three color ultrasonic doppler combined with power doppler ultrasound,improving the accuracy of the measured ultrasonic indicators predicting ovarian reserve function. And ovarian reserve mainly depends on the remaining the number of primordial follicle in stationary phase, ovarian function is not affected by hormone levels when after pituitary. The ovaries sinus follicle number and ovarian stromal blood flow index can reflect the quantity and quality of the remaining original follicle ovarian reserve function. According to this theory, With the help of three power doppler ultrasound monitoring the number of sinus follicles and ovarian volume and ovarian stromal blood flowmakes more sense.ObjectiveThe aim of this study is to Compare the antral follicle counts(AFC)、the mean ovarian volume (MOV) and vascularization index (VI)、flow index (FI) and vascularization flow index (VFI)by the vaginal three-dimensional ultrasonography (3D-US)and power Doppler angiography(PDA)on the day of pituitary suppression control,combined with the basal levels of the follical stimulating hormone(FSH)、the follical stimulating hormone/luteinizing hormone ratio (FSH/LH) and estradiol (E2)in serum and so on, Analyzing whether these measurements can predict ovarian resere and pregnancy outcomes for the young patients with regulation of menstrual cycle normal FSH.Further analysis the optimal predictor of ovarian reactivity and reproductive potential of these patients with different age groups, to discusse the inner relation between the indicators of ultrasound and clinical,to select the better predictors and assess ovarian reserve function comprehensively and accurately to guide therapy and achieve the purpose of improve the success rate of assisted reproductive technology.MethodsThe study included one hundred and seventy-one women who had undergone IVF/ICSI-ET in the reproductive medicine center of the first affiliated hospital of Zhengzhou university from Jul2012to Oct2012.The range of the patiens age was21-35years.They have regular menstrual cycles and have normal basal FSH (<8.5IU/L).They have been infertile between land10years.The reason of infertility included male factor、female fallopian tubal factor mixed factor and unexplained infertility. All the research objects have undergone the first IVF/ICSI-ET.Laboratory Analysis:1.The hormones including FSEL LH and E2were measured by ECLIA on the2-4days during the menstrual cycle in IVF/ICSI-ET1-3months before pregnancy.2.The basal follical stimulating hormone concentrations were measured following the pituitary suppression of14days before the administration of gonadotropins.3. When reaching standard of the pituitary suppression,using transvaginal ultrasound scan of the ovaries and fixed vaginal probe to scan and save each ovary information when gaining the most clearly ovarian. Using the multi plane imaging mode tracing the ovarian trajectory and Calculate each ovarian volume automatically by VOCAL. Vascularization index (Ⅵ)、flow index (FI) and vascularization flow index (VFI) was measured by the volume histogram. Sona AVC was used to measure the number and volume of follicles by3D ultrasound Sono automatic volume calculation.Results1, The relationship between3D-power Doppler index the ovarian and response:AFC,MOV, FI were significantly different between the normal response group and the low response group (P<0.01). Ⅵ and VFI follwing the pituitary suppression cycle were no significantly different between the normal response group and the low response group(p>0.05).2, The related analysis egg number and the indexes of ovarian reserves:The correlation coefficientb betwwen the number of oocytes retrived and AFC,MOV, basalFSH/LH, FI respectively are0.570>0.459.-0.226,0.178(p<0.01), the correlation of strength respectively are AFC,MOV,bFSH/LH, FI.3> The relationship between3D-power doppler index and the pregnancy outcome:(1) Ⅵ,FI, VFI were significantly differet between the normal response group and the low response group(P<0.01).(2)AFCn MOV follwing the pituitary suppression cycle were no significantly different between the normal response group and the low response group(P>0.05). Ⅵ,FI, VFI has a certain prediction value for pregnancy outcome,and Three indicators has the highest sensitivity and specific degrees to predict pregnancy outcome when the define the valuesIn2.860,25.474,1.186, respectively.4> Comparison between the different age groups by3D-power Doppler:(1)FI were significantly differet between C group and A, B group(P<0.01).(2)AFC were significantly differet between C group and B group((P<0.01).(3) Ⅵ、VFI、MOV were no significantly different between the three groups(P>0.05).Conclusions1、The number of antral follicles on the day of pituitary suppression control are the best predictors of the ovarian reserve function for the young patiens with normal FSH.2、FI can predict ovarian response on one point after the pituitary suppression control and there have been meaningful for screening low overian response earlier. FI、Ⅵ、VFI are also significantly related to pregnancy outcome.3、The young patients with infertility and normal basal FSH exist low ovarian response and the patients ovarian perfusion has a downward trend after entering30years old,and ovarian reactivity has tendency to decline. |
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