The Study Of Predictive Indicators About Ovarian Response And The Pregnancy Outcomes In Patients With IVF-ET

Objective:To evaluate the predictive value of Age,AFC,bFSH,bFSH/bLH,AMH,FORT on the ovarian reactivity and the pregnancy outcome in patients who undergoing in vitro fertilization-embryo transfer(IVF-ET).Method:The 229 cases of patients who asking for IVF-ET treatment were recuited in our hospital from December 2015 to January 2018.The blood level of basic hormones and AMH were measured and the number of antral follicle were counted on 3~5 day of menstrual cycle.The patients are injected gonadotropin-releasing hormone agonis according the different proptocols.Before the r-FSH administration day to use the ultrasound evaluate the follicle number whose diameter from 3-8 mm and the number of preovulatory follicle with 16-22 mm diameter,Calculate the FORT.According to the standard of retrieved oocytes to divided the patients into three groups: hyper-ovarian response(>15 retrieved oocytes,HOR),poor ovarian response(?3 retrieved oocytes,POR)and normal ovarian response(between 3 and 15 retrieved oocytes,NOR).The differences of age,AFC,bFSH,bFSH/bLH,AMH and FORT among three groups were analyzed and the correlation of thoes indexes wiht the number of retrieved oocytes were also evaluated.And we also evaluate the predict ovarian reactivity value of each index by using the receiver operating characteristic curve(ROC).Fruthermore,we divided the patients into the pregnancy and ono-pregnanct group,compared the differences in general information as well as the indicators of these two groups,to assess the clinical value of these indicators in IVF-ET.Results:1.There was a significant difference for AFC,AMH and FORT among three groups(P<0.05).The age and bFSH/bLH in the high-response group were significantly different from those in other groups(P<0.05).The bFSH in the low-response group was significantly different from that in other groups(P<0.05).2.Age,FSH,bFSH/bLH were negatively correlated with the number of oocytes(correlation coefficient-0.278,-0.258,-0.375,P<0.05).But AFC,AMH and FORT were positively correlated with the number of retrieved oocytes(correlation coefficient 0.604,0.629,0.279,P<0.05).3.The areas under ROC curve(AUC)of age,AFC,bFSH,bFSH/bLH,AMH,FORT were 0.621,0.231,0.662,0.598,0.214,0.243 for prediction of the poor response.Suggestting that the age,bFSH and bFSH/bLH has higher predictive value(AUC > 0.5).Accorrding to the ROC curve we can konw the best predictive cut-off point of the Age for predicting ovarian low-response is 34.5 years old(sensitivity 54.4%,specificity 75.2%);The best predictive cut-off point of the bFSH was 8.65mIU/ml(sensitivity 66.7%,specificity 78.5%);The best predictive cut-off point of the bFSH/bLH is 3.05(sensitivity 33.3%,specificity 94.4%).4.The areas under ROC curve(AUC)of age,AFC,bFSH,bFSH/bLH,AMH,FORT were 0.573,0.356,0.525,0.641,0.330,0.437 for prediction of the normal response.Suggestting that the age,bFSH and bFSH/bLH has higher predictive value(AUC > 0.5).Accorrding to the ROC curve we can konw the best predictive cut-off point of the Age for predicting ovarian normal-response is 32.5 years old(sensitivity 50.0%,specificity 33.3%);The best predictive cut-off point of the bFSH was 7.05mIU/ml(sensitivity 56.5%,specificity 46.7%);The best predictive cut-off point of the bFSH/bLH is 1.14(sensitivity 79.93%,specificity 48.0%).5.The areas under ROC curve(AUC)of age,AFC,bFSH,bFSH/bLH,AMH,FORT were 0.378,0.749,0.420,0.308,0.784,0.653 for prediction of the high response.Suggestting that the AFC,AMH and FORT has higher predictive value(AUC > 0.5).Accorrding to the ROC curve we can konw the best predictive cut-off point of the AFC for predicting ovarian hyperresponsive is 12.5(sensitivity 73.3%,specificity 62.7%);The best predictive cut-off point of the AMH was 3.62ng/ml(sensitivity 68.3%,specificity 31.7%);The best predictive cut-off point of the FORT is 67.26%(sensitivity 76.7%,specificity 54.4%).6.There was no significant difference in age,AFC,bFSH,bFSH/bLH,AMH,FORT,and the number of retrieved oocytes between the the pregnant and non-pregnant groups(P>0.05).Conclusion:1.According to the study,age,AFC,bFSH,bFSH/bLH,AMH and FORT were all predictive of ovarian reactivity;age bFSH and bFSH/bLH are significantly better than others indicators in predicting lower response and normal response.AFC,AMH and FORT are significantly better than others indicators in predicting high respons.2.In the IVF-ET process,age,AFC,bFSH,bFSH/bLH,AMH,and FORT alone had no predictive value for the pregnancy outcome of the fresh IVF-ET cycle.