A Study On The Predictive Value Of Ovarian Reserve Evaluation Indicators For The Outcome Of Assisted Pregnancy In Women With Low Fertility

Objective The purpose of the study was to understand the basic health information,causes of infertility,and types of infertility for women with low fertility,to evaluate the predictive value of ovarian reserve evaluation indicators for clinical pregnancy in women with low fertility;and to compare the similarities and differences in the predictive value of women receiving ART technology and non-ART technology treatments,to provide a scientific evidence for clinical diagnosis and treatment guidance.Methods This study was a clinical follow-up study.The data were derived from the project of "analysis on the incidence of low fertility in the population of childbearing age and the current situation of intervention",in which it selected 13 assisted reproductive institutions with large outpatient volume in east,central and west regions.The study collected baseline characteristics(age,BMI,smoking and drinking frequency),reproductive health-related conditions(duration of infertility,cause of infertility,whether to apply ART treatment and the type of ART),some ovarian reserve evaluation Indicators(sex hormones,AMH,AFC)and clinical pregnancy outcome,and detection methods of FSH,AMH,AFC in assisted reproductive institutions.Clinical pregnancy was selected as an variable for the assisted pregnancy outcome in this study.Non-parametric tests(Mann-Whitney U test)and stepwise logistic regression were used to analyze the influencing factors.The receiver operating characteristic curve(ROC curve)was employed to calculate AUC,sensitivity,and specificity for the predictive values.Results There were 3421 subjects enrolled in this study,of which,1493(43.64%)and 1928(56.36%)women were selected for ART and non-ART treatment.The selection of ART treatments from high to low was IVF(61.56%),AIH/AID(29.87%),and ICSI(8.57%).Among the included women,there were 2694 infertile women(infertility duration≥1 year).The number of primary infertility and secondary infertility were 1565(58.10%)and 1129(41.90%).The proportion of infertility causes from high to low were fallopian tube factor(45.03%),other causes(23.61%),ovulation disorder(18.00%),unknown cause(8.69%),and endometriosis(4.67%).For women receiving non-ART treatment,the indicators with predictive value from high to low was age,AMH,AFC,T,PRL.Age combined AMH was the dual indicator combination with the highest predictive value,AUC was 0.641.And the combination with the highest predictive value was age combined AMH,T,AFC,FSH,and PRL,AUC was 0.650.Sensitivity and specificity were 69.80%and 51.30%,respectively.In the 20-34-year-old group,only age had predictive value and statistical significance.Age combined AMH was the dual indicator combination with the highest predictive value,AUC was 0.602.And the combination with the highest predictive value was age combined AMH,T,AFC,FSH,AFC,AUC was 0.616,sensitivity and specificity were 69.80%and 51.30%,respectively.In the 35-45-year-old group,the indexes with the high to low predictive value was age,PRL,AMH,T.Age combined AMH was the two-index combination with the highest predictive value,AUC was 0.602,and the combination with the highest predictive value was age combined FSH,AMH,AFC,PRL and T,AUC was 0.672,sensitivity and specificity were 66.60%and 63.00%,respectivelyWith regards to women treated with IVF/ICSI,the indicators of predictive value from high to low was age,AFC,AMH,FSH,LH,and T.In the analysis of joint indicators,the combination of age and AMH had the highest predictive value in the dual indicator combination,with AUC of 0.670.The predictive value of age combined LH,AMH,and FSH was the highest,with AUC of 0.675,sensitivity and specificity were 58.20%and 68.10%,respectively.In the 20-34-year-old group,only age had predictive value,and AUC was 0.591.Age combined T was the dual indicator combination with the highest predictive value,and AUC was 0.606.The combination with the highest predictive value was age combined T,AMH,and FSH,AUC was 0.622,sensitivity and specificity were 67.20%and 49.80%,respectively.In the 35-45 year old group,the indicators from high to low was age and FSH,and AUC were 0.667 and 0.589,respectively.Among the combined indicators,age combined AMH was the dual indicator combination with the highest predictive value,with AUC of 0.671.The combination with the highest predictive value was age combined AMH and FSH,with AUC of 0.677,sensitivity and specificity were 50.90%and 77.20%,respectively.For women receiving AIH/AID treatment,age and PRL had predictive value,AUC were 0.618,0.558.In the combination of age combined single indicators,age combined PRL was the dual indicator combination with the highest predictive value,and the AUC was 0.628.Among all indicators combinations,the combination with the highest predictive value was age combined PRL,AMH,AUC is 0.634,sensitivity was 56.20%,and specificity was 64.00%.In the 20-34-year-old group,the indicators of ROC analysis predicting value from high to low was age,PRL and P,and AUC were 0.604,0.589 and 0.548,respectively.Age combined PRL was the dual indicator combination with the highest predictive value,AUC was 0.608.The combination with the highest predictive value was age combined PRL,P,and AFC.The AUC was 0.610,the sensitivity was 56.20%,and the specificity was 64.00%.There was no statistical difference in all indicators of single factor analysis in the 35-45-year-old group.Because the 35-45-year-old group did not meet the sample size requirement,logistic regression and ROC analysis were not performedConclusion In women 20-34 years of age,age can be used as a predictor of clinical pregnancy regardless of treatment.In women 35-45 years old,age and AMH can be used as predictors of clinical pregnancy in women treated with non-ART.Age and FSH can be used as predictors of clinical pregnancy in women treated with IVF/ICSI.