生殖医学杂志

目的探究在高龄女性中,卵泡期长效长方案控制性卵巢刺激(COS)的临床结局及影响临床妊娠和卵巢反应的关键因素。方法回顾性分析行卵泡期长效长方案COS的411例高龄(35～44岁)女性的临床资料。运用Logistic回归筛选每移植周期临床妊娠及卵巢低反应的独立影响因素。运用受试者工作特征(ROC)曲线下面积(AUC)评估各独立影响因素的预测准确度。结果所纳入患者的基础AMH值介于0.25～14.51 ng/ml,平均(3.23±2.21)ng/ml。35～39岁患者每移植周期临床妊娠率39.02%～55.00%。40岁及以上患者每移植周期临床妊娠率为16.67%(5/30)。当基础AMH≤1.0 ng/ml时,卵巢低反应的发生率为56.52%(13/23);基础AMH>1.5 ng/ml时,卵巢低反应的发生率为4.76%(16/336)。Logistic回归显示,年龄[OR=0.777,95%CI(0.654,0.923)]、BMI [OR=0.858,95%CI(0.753,0.977)]、HCG日LH水平[OR=0.690,95%CI(0.485,0.982)]是每移植周期临床妊娠的独立影响因素(P<0.05)。ROC曲线分析显示年龄、BMI、HCG日LH水平预测每移植周期临床妊娠的AUC分别为0.540、0.571、0.528。另外,基础AMH是卵巢低反应的唯一独立影响因素[OR=0.359,95%CI(0.213,0.603)](P<0.001),其预测卵巢低反应的AUC为0.831。结论在运用卵泡期长效长方案COS的卵巢储备功能尚可的高龄女性中,35～39岁患者的每移植周期临床妊娠率较理想;体重控制及COS过程中LH水平的控制有助提高每移植周期临床妊娠率;基础AMH是卵巢低反应的唯一独立影响因素,可有效预测卵巢低反应。

Objective:To explore the clinical outcome of controlled ovarian stimulation(COS) and the key factors affecting clinical pregnancy and ovarian response in the long-acting GnRH agonist long protocol in follicular phase.Methods:The data of 411 elder women(35-44 years) administered with long-acting GnRH agonist long protocol were retrospectively analyzed. Logistic regression was applied to identify the independent risk factors of clinical pregnancy rate per transfer cycle and poor ovarian response. The prediction accuracy of the independent risk factors was evaluated by calculating the area under the receiver operating characteristic(ROC) standard curve(AUC).Results:Baseline AMH levels in included patients were between 0.25 ng/ml and 14.51 ng/ml,and mean±SD of which was(3.23±2.21) ng/ml. The clinical pregnancy rate per transfer cycle was between 39.02% and 55.00% in women aged 35 to 39. The clinical pregnancy rate per transfer cycle was 16.67%(5/30) in women aged ≥40. In patients with AMH level ≤1.0 ng/ml,the rate of poor ovarian response was 56.52%(13/23). In patients with AMH level >1.5 ng/ml,the rate of poor ovarian response was 4.76%(16/336). Multivariate logistic regression analysis showed that age [OR=0.777,95%CI(0.654,0.923)],BMI [OR=0.858,95%CI(0.753,0.977)],LH level on HCG day [OR=0.690,95%CI(0.485,0.982)] were independent affecting factors of the clinical pregnancy rate per transfer cycle(P<0.05). ROC curve analysis showed that AUC for predicted the clinical pregnancy rate per transplant cycle by age,BMI,and LH level on HCG day was 0.540,0.571 and 0.528,respectively. In addition,basic AMH was the only independent influencing factor of ovarian hypo-responsiveness [OR=0.359,95%CI(0.213,0.603)](P<0.001),and its AUC for predicting ovarian hypo-responsiveness was 0.831.Conclusions:Administration of long-acting GnRH agonist long protocol in women aged 35 to 39 can achieve good outcomes of clinical pregnancy per transfer cycle. Controlling weight and LH level during COS can improve the pregnancy rate per transfer cycle. Baseline AMH is only independent risk factor for poor ovarian response,which can effectively predict low ovarian response.