The Clinical Study On The Predictive Value Of Serum And Quantitative Assay Of Urinary FSH And LH After GnRH Agonist Down-regulation

Objectiv:This study is to investigation the predictors of ovarian response through analysis of relationship between the predictors of ovarian reserve including patient’s age, serum follicle-stimulating hormone levels (FSH), luteinizing hormone (LH)with ovarian response among the patients who undergone in vitro fertilization and embryo transfer after GnRH agonist down-regulation. By exploring the predictive ability of them by ROC curve and analyzing the predictive value of the combination of indicators, we can work out an individualized ovarian stimulation method for patient, improve the clinical pregnancy rate.To identify the value of quantitative assay of urinary FSH and LH after GnRH agonist down-regulation during in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. This study is also taking some effort to find the relationship between serum FSH, LH and urinary FSH, LH.Materials and Methods:The data of752cycles from the Second Affiliated Hospital of Kunming Medical University from October2012to January2014were retrospectively analyzed. There are208cycles of them both analyze serum and urinary FSH and LH. The serum FSH, LH and urinary FSH, LH were assayed on the gonadotropin starting day. This208cycles were divided into three groups.The number of retrieved oocytes, age, total gonadotropin dose, clinical pregnancy rate etc. among the three groups and the correlation between serum FSH,LH and urinary FSH, LH were analyzed. We define the ovarian response according to the number of retrieved oocytes and poor ovarian response as the number of retrieved oocytes≤3and high ovarian response as the number of retrieved oocyte≥20. The patients were divided into poor ovarian response group, normal ovarian response group and high ovarian response group and compared the predictors among the three groups. All data were processed by SPSS17.0software, compare the basic characteristics and the treatment of the patients among the different groups using one-way ANOVA or Welch approximate variance analysis and Chi-Square test. Then compare the diagnostic utility of the predictors by receiver operating curve (ROC) and analyze the relationship between the predictors of ovarian reserve with ovarian response by Spearman correlation and Logistic Regression.Result:1.There were significant differences in the patients’ age, serum FSH levels, total Gn, total number of eggs, normal fertilized oocytes, good quality embryo among the three groups(P<0.01), serum FSH/LH in the different ovarian response groups was also significant difference(P<0.05).2. After age be grouped, serum FSH had significant difference between peopoe in different ovarian reactive groups, there was no significant difference between serum LH and FSH/LH.3. Spearman correlation analysis showed that the serum FSH negatively correlated to the number of eggs, the correlation coefficient(r) in Ⅰ-Ⅲ group were0.183,0.196,0.258, P<0.01. Serum FSH/LH also correlated to the number of eggs in group Ⅱ and group Ⅲ, the correlation coefficient(r) were-0.136、-0.143, P<0.05.4. ROC curve analysis showed that serum FSH levels were good parameters to predict the high ovarian response in group Ⅰ. The predictive value of serum FSH levels, LH levels and FSH/LH for ovarian response is limited in group Ⅱ. In our study, ROC curve analysis showed that serum FSH levels is a good parameter to predict the poor or high ovarian response in group Ⅲ.5. Logistic regression analysis showed that the patient’s age, serum and FSH levels were included into model to predict poor and high ovarian response. Combining the two parameters can improve the prediction efficiency. They are the protective factors to poor ovarian response and to be the dangerous factors to high ovarian response..6. The urinary FSH correlated to the number of eggs, the correlation coefficient(r) were-0.152, P<0.05; Logistic regression analysis showed that urinary FSH can predict poor ovarian response.7. The urinary FSH and LH levels was significantly correlated to the serum FSH(r=0.508, P<0.01) and LH(r=0.328, P<0.05) levels.Conclusions:1. The serum FSH levels and FSH/LH on the gonadotropin starting day after GnRH agonist down-regulation were good parameters to predict the poor ovarian response. Those two parameters combining the patient’s age can improve the prediction efficiency.2. The urinary FSH, LH were correlated to the serum FSH, LH.3. The quantitative urinary FSH could been used in IVF for predicting the ovarian response.