Study On Follicular Sensitivity Index And Ovarian Response In In Vitro Fertilization-Embryo Transfer

OBJECTIVE:To study and compare the correlation between follicular sensitivity index(FSI),follicle output rate(FORT),ovarian sensitivity index(OSI)and ovarian response in in vitro fertilization-embryo tranfer(IVF-ET),and the clinical application value of the three.METHODS:This present retrospective cohort study included infertility women who underwent IVF-ET from April 2009 to December 2015 in the Reproductive Center of Northern Jiangsu People’s Hospital.By analyzing the clinical data including IVF/ICSI cycle basic data and ovulation induction program,the value of FSI,OSI,and FORT was evaluated for ovarian response in patients who choose long-term.The pregnancy outcome was analyzed and the values of FSI,OSI,and FORT were compared to predict the cumulative pregnancy outcome of the ovulation cycle.Using patients with different causes of infertility to analyze the clinical data of patients with different causes of infertility,and to study the application value of FSI.Using the first and second COH treatment patients to compare the clinical data of the first and second COH treatments and compare the application value of FSI.Further analysis of FS1 was conducted to investigate the value of FSI in patients with various ovulation-inducing protocol in patients like mild stimulation protocol,Gonadotropin-releasing hormone antagonist(GnRH-A)protocol,and other regimens et al.RESULTS:(1)AFC,FORT,FSI,OSI,PFC were positively correlated with the number of oocytes retrievaled,and the correlation coefficient between FSI and the number of oocytes retrievaled was second only to OSI and PFC.According to the FSI group,three groups of data were compared,including infertility years,mean age,BMI,basal FSH/LH,HCG day P level,FSH starting dose,down-regulation dose,Gn days,total Gn dosage,number of oocytes retrievaled,Th e distribution of PFC,OSI,FORT,and FSI in the three groups were different(p<0.05).(2)Female age,infertility years,basal FSH/LH,AFC,PFC,HCG day P level,FSH starting dose,total Gn dose,number of oocytes retrievaled,number of 2PN,2PN fertilization rate,number and rate of transplantable embryos,number and quality of high-quality embryos,FSI,OSI,FORT were statistically different.According to the area under the ROC(receiver operating characteristic curve)curve of FSI,OSI,FORT,the predicted value of the treatment outcome is the best OSI,the FSI is the second,and the FORT is the worst.With the increase of FSI,female age,infertility years,BMI,basal FSH/LH,FSH start-up dose,Gn days,total Gn dosage decreased,HCG day P level,PFC,FORT,number of oocytes retrievaled,OSI,total 2PN number,2PN fertilization rate,number of high quality embryos,and number of transplantable embryos showed an increasing trend.Planting rate,cumulative pregnancy rate,biochemical pregnancy rate,embryo implantation rate,and live birth rate all increased with the increase of FSI,and the difference between the three groups were statistically significant.(3)The age,basal FSH/LH and the total amount of Gn of the patients with endometriosis were the largest,but BMI,AFC,PFC,number of oocytes retrievaled,2PN number and fertilization rate,number and rate of transplantable embryos,number and rate of high quality embryos,OSI,as well as FSI,were minimum.The age,BMI,AFC,PFC,number of oocytes retrievaled,OSI and FSI were the highest in PCOS patients,but the total amount of Gn was the smallest.The patients with tubal factors had the largest FORT.The correlations between FSI,OSI,FORT related to tubal factors,endometriosis,ovulation abnormality,pcos,with no abnormalities and ovarian reactivity were OSI>FSI>FORT.The value of three indicators,FSI,OSI and FORT,predicting the pregnancy outcome of five kinds of female infertility reasons,as tubal factors,ovulation abnormalities,PCOS,no abnormal women,endometriosis,was the best OSI,the second FSI,the worthest FORT.There were no significant differences in biochemical pregnancy rate,clinical pregnancy rate,cumulative pregnancy rate,and live birth rate among the five groups.The difference was statistically significant in the implantation rate among the five groups(p<0.05).(4)The second promotion of the same patient than the first promotion age,infertility time,total Gn,2PN fertilization rate,number of transplantable embryos,number of high quality embryos,biochemical pregnancy rate,implantation rate,clinical pregnancy rate,cumulative pregnancy rate and live birth rate are high.The correlation coefficient between OSI,FSI and the number of oocytes retrievaled during the second promotion cycle was higher than that of the first promotion.In the second oocytes retrieval-transplant cycle,OSI and FSI predicting the outcome of pregnancy is better than the first.(5)Among the four groups of patients with different ovulation induction protocol,the age,infertility time,and the basic FSH/LH were the smallest in the long-term group,while AFC,PFC,number of oocytes retrievaled,2PN number,transplantable embryos,number of high-quality embryos,and OSI were maximum.The correlation coefficient between the three indicators of FSI,OSI and FORT and the four group were OSI>FSI>FORT.OSI predicts whether the value of pregnancy in four ovulation induction protocol groups of patients is better than FSI and FORT.The biochemical pregnancy rate,clinical pregnancy rate,cumulative pregnancy rate and live birth rate of the long-term protocol group were the highest,and the antagonist group was the lowest.The biochemical pregnancy rate,clinical pregnancy rate and live birth rate of the four groups were statistically different(p<0.05).CONCLUSION:(1)In patients with long-term ovulation induction,FSI value has a certain evaluation effect on COH ovarian response,and it is an effective indicator for predicting pregnancy outcome.FSI has the best predictive effect on ovarian response and predictive outcomes in patients with abnormal ovulation.Patients who have been received long-term ovulation therapy for many times can adjust the treatment plan and dosage of the next ovulation induction treatment according to the FSI of the first ovulation induction therapy.(2)FSI is more valuable in patients with standard long-term ovulation induction protocols,and is less effective than OSI and FORT in patients with microstimulation and antagonist protocols.