Study On The Predictive Index Of Ovarian Response And Pregnant Outcomes In Assisted Reproductive Technology

Objective To explore the predictive index of ovarian response and pregnant outcomes in assisted reproductive technologyMethods Retrospective analysis on clinical data of 1305 cases of patients who had accepted IVF/ICSI-ET in the reproductive center from April 2009 to December 2015.(1)According to the egg numbers they gained,the patients were divided into different groups,low reaction group(egg numbers <5),normal reaction group(egg numbers5-20),high reaction group(egg number >20).Comparative analysis of patients' general situation and pregnant outcomes.If these parameters have significant statistical difference among different groups,we performed a secondary analysis.ROC curves were used for the prediction of ovarian response.(2)To explore the relationship among the AFC?FSH?FSH/LH?LH?age and retrieval egg numbers(3)Age was divided into two groups(age<35 or age?35);AFC was divided into three groups(AFC<4,AFC=4-9 or AFC?10);Estradiol was divided into two groups(E2<292.8pmol/L or E2?292.8pmol/L);FSH was divided into two groups(FSH<10U/L or FSH?10U/L);FSH/LH ratio was divided into two groups(FSH/LH<3 or FSH/LH?3).Then we analyzed the relationship among those index,IVF/ICSI fertilization,embryo qualities and pregnancy outcomes.Results(1)These three groups of patients with different ovarian response had difference in age,infertility duration,FSH,FSH/LH ratio,AFC,cycle cancellation rates and body mass index(p<0.05).The cycle cancellation rate of the low reaction patients group is up to 49.2%.The OHSS rate of the high reaction patients group was up to 11.2%.(2)There was no statistical significance on the cumulative pregnancy rate,live birthsrate,miscarriage rate,the rate of twins and ectopic pregnancy rate among the three groups with different ovarian response.(3)The ovarian response predictive relevant factors we performed a secondary analysis for ROC curves.As a result,AFC and LH value can be used for high ovarian response prediction.AFC is better than LH value.Age,FSH,FSH/LH ratio and BMI can be used for low ovarian response prediction.Age is the best.(4)Cycle cancellation rate of the group of AFC < 4 was higher than AFC from 4 to 9 group and AFC?10 group.Cycle cancellation rate of the group of FSH ?10 was higher than FSH<10U/L group.Also cycle cancellation rate of the group of FSH/LH ? 3 was higher than FSH/LH<3 group.The difference had statistical significance.(5)Normal fertilization rate of the group of age< 35 was higher than age ?35 group.Normal fertilization rate of the group of E2< 292.8 pmol/L was higher than E2?292.8 pmol/L group.Normal fertilization rate of the group of FSH?10U/L was higher than FSH<10U/L group.Also normal fertilization rate of the group of FSH/LH ? 3 was higher than FSH/LH < 3 group.The difference had statistical significance.The excellent embryo rate of the group of E2? 292.8 pmol/L was higher than E2< 292.8 pmol/L group.Also the excellent embryo rate of the group of FSH ?10 U/L was higher than FSH <10 U/L group.The excellent embryo rate of the group of AFC<4 was obvious lower than AFC from 4 to 9 group and AFC?10 group.The difference had statistical significance.The grow rate of the group of age < 35 was higher than age ?35 group.Also the grow rate of the group of AFC?10 was higher than AFC from 4 to 9 group.The difference had statistical significance.(6)When E2?292.8 pmol/L combined with age ?35,the mulative pregnancy rate of that group was only 16.67%,compared to the group of E2?292.8 pmol/L combined with age < 35.The difference had statistical significance.(7)All of the groups can not predict miscarriage rate,the rate of twins and ectopic pregnant rate.The difference had no statistical significance.Conclusions(1)In assisted reproductive technology,the parameters of the patient,such as AFC,age of patients,BMI,FSH/LH ratio,FSH and LH,have effect on each other.It was positive correlation or negative correlation.Though antral follicle count was goodat predicting ovarian high reactivity,age was good at predicting low ovarian response.Ovarian reactivity can not predict pregnant outcomes.(2)Single index such as FSH/LH,AFC and FSH,could predict cycle cancellation rate.AFC has no effect on the IVF/ICSI normal fertilization rate.Age has no effect on the IVF/ICSI excellent embryo rate while it affects embryo grow rate.No Single index can predict the cumulative pregnancy rate,but when age combined with AFC or E2,it could predict the cumulative pregnancy rate.The indicators cannot predict IVF/ICSI miscarriage rate.