卵巢庫存測試和病人的年齡對生育的影響





出處:第一名的不孕症期刊 Hum Reprod Update. 20131月搶鮮版

 
荷蘭的研究

 

卵巢庫存測試和病人的特點在預測卵巢反應和繼續妊娠的影響:病人個別特徵的研究。

抽象
背景雖然卵巢儲備測試(ORTS),是經常使用之前,試管嬰兒治療結果的預測,其預測值增值尚不清楚。我們評估了
卵巢庫存測試和病人的特點,在預測IVF的結果的附加價值。方法對患者的個人數據(IPD)發表的研究報告進行綜合分析。 FSH,抗苗勒管激素(AMH)或基礎卵泡計數(AFC)的婦女接受試管嬰兒的研究和作者聯繫。使用隨機攔截logistic回歸模型,我們估計增加的預測值卵巢儲備測試(ORTS)相對於病人的特點,是否能增加預測試管嬰兒懷孕後的結果。

 

結果,我們能夠收集到28個數據庫,包括5705名婦女接受試管嬰兒。預測反應不佳的女性年齡在(AUC)下面積為0.61 AFCAMH顯著地提高了模型的擬合(P<0.001)。此外,幾乎類似的準確率達到使用AMHAFC獨自的(AUC分別為0.780.76)。結合這兩個測試,但是,並沒有提高反應不佳的預測(AUC 0.80P = 0.19)。在預測試管嬰兒(IVF)後繼續妊娠,年齡是最好的單一預測(AUC 0.57),卵巢儲備測試(ORTS)如低的AMH,少的基礎濾泡(AFC)及高的FSH並且沒有對預測試管嬰兒(IVF)後繼續妊娠有任何價值,年齡對預測試管嬰兒(IVF)後繼續妊娠是最好的單一預測。結論這IPD薈萃分析表明,AFCAMH明確添加到年齡在預測對預測試管嬰兒(IVF)後繼續妊娠反應不佳。作為單個試驗,AFCAMH都完全預測卵巢低反應。相反的ORTS,沒有添加任何信息的能力有限,只有女性年齡來預測IVF後繼續妊娠。

 

醫師的意見:

卵巢庫存測試(ORTS)如低的AMH,少的基礎濾泡(AFC)及高的FSH並且沒有對預測試管嬰兒(IVF)後繼續妊娠有任何價值,年齡對預測試管嬰兒(IVF)後繼續妊娠是最好的單一預測。卵巢庫存測試(ORTS)如低的AMH,少的基礎濾泡(AFC)及高的FSH只能預測排卵藥刺激的反應。40歲不管卵巢庫存測試(ORTS)是否良好,仍有50%的流產率(多因染色體異常的胚胎,高齡的卵及胚胎易突變)。年齡才是測試管嬰兒(IVF)後繼續妊娠到不流產而染色體正常而生下來的關鍵。

 

 

原文

Hum Reprod Update. 2013 Jan;19(1):26-36. Epub 2012 Nov 27.

Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach.

Broer SLvan Disseldorp JBroeze KADolleman MOpmeer BCBossuyt PEijkemans MJMol BWBroekmans FJon behalf of the IMPORT study group.

Collaborators (35)

Broer SLvan Disseldorp JBroeze KADolleman MOpmeer BCAnderson RAAshrafi MBancsi LCaroppo LECopperman AEbner TEldar Geva MErdem MGreenblatt EMJayaprakasan KFenning RKlinkert ERKwee JLambalk CBLa Marca AMcIlveen MMerce LTMuttukrishna S,Nelson SMNg HYPopovic-Todorovic BSmeenk JMTomás CVan der Linden PJvan Rooij IAVladimirov IKBossuyt PBEijkemans MJMol BWFrank B.

Source

Department of Reproductive Medicine, University Medical Center Utrecht , Room F05.126, P.O. Box 85500 , Utrecht 3508 GA, The Netherlands .

Abstract

BACKGROUND Although ovarian reserve tests (ORTs) are frequently used prior to IVF treatment for outcome prediction, their added predictive value is unclear. We assessed the added value of ORTs to patient characteristics in the prediction of IVF outcome. METHODS An individual patient data (IPD) meta-analysis from published studies was performed. Studies on FSH, anti-Müllerian hormone (AMH) or antral follicle count (AFC) in women undergoing IVF were identified and authors were contacted. Using random intercept logistic regression models, we estimated the added predictive value of ORTs for poor response and ongoing pregnancy after IVF, relative to patient characteristics. RESULTS We were able to collect 28 study databases, comprising 5705 women undergoing IVF. The area under the receiver-operating characteristic curve (AUC) for female age in predicting poor response was 0.61. AFC and AMH each significantly improved the model fit (P-value <0.001). Moreover, almost a similar accuracy was reached using AMH or AFC alone (AUC 0.78 and 0.76, respectively). Combining the two tests, however, did not improve prediction (AUC 0.80, P = 0.19) of poor response. In predicting ongoing pregnancy after IVF, age was the best single predictor (AUC 0.57), and none of the ORTs added any value. CONCLUSIONS This IPD meta-analysis demonstrates that AFC and AMH clearly add to age in predicting poor response. As single tests, AFC and AMH both fully cover the prediction of poor ovarian response. In contrast, none of the ORTs add any information to the limited capacity of female age to predict ongoing pregnancy after IVF. The clinical usefulness of ORTs prior to IVF will be limited to the prediction of ovarian response.



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