Use of stimulated serum estradiol measurements for the prediction of hyperresponse to ovarian stimulation in in vitro fertilization (IVF)
Use of stimulated serum estradiol measurements for the prediction of hyperresponse to ovarian stimulation in in vitro fertilization (IVF)
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DOI：
10.1023/b:jarg.0000027016.65749.ad
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发表时间：
2004-03-01
影响因子：
3.1
通讯作者：
Broekmans, FJ
中科院分区：
文献类型：
--
作者：
Hendriks, DJ;Klinkert, ER;Broekmans, FJ
目的：在卵巢刺激中，经常可以看到过度的卵巢反应，这与医学并发症有关，如卵巢过度刺激综合征（OHSS）和患者不适增加。如果有可能在刺激阶段的早期阶段识别超反应者，则刺激方案的调整将变得可行，以最大限度地减少潜在的并发症。因此，我们研究了测量刺激的血清雌二醇（E-2）水平在预测卵巢过度反应中的有用性。方法：前瞻性纳入了总共109名使用GnRH激动剂长期方案进行第一个IVF治疗周期的患者。在刺激阶段的第3天和第5天评价E-2水平。定义了两个结局指标。第一种是卵巢过度反应（采集时收集了大于或等于15个卵母细胞和/或峰值E-2 > 10000 pmol/L，或由于生长大于或等于30个卵泡和/或峰值E-2 > 15000 pmol/L而取消，或出现OHSS）。第二个结果指标包括一个亚组，代表更严重的超反应，命名为极端反应（取消或OHSS开发）。在刺激第3天测量的E-2对卵巢过度反应的预测准确性明显低于刺激第5天测量的E2（受试者工作特征曲线下面积（ROCAUC）分别为0.75和0.81）。对于极端反应，在刺激第3天或第5天测量的E-2的预测准确性相当（ROCAUC分别为0.81和0.82）。对于这两个结果的措施，刺激E-2测试只产生了可接受的特异性与中等灵敏度在较高的截止水平。极端反应的预测似乎稍微更有效，由于较低的错误率。结论：有一个显着的预测之间的关联E-2水平刺激第3天和第5天，卵巢过度反应和极端反应IVF。然而，刺激的E-2水平的预测过度反应的临床价值是低的，因为适度的敏感性和高的假阳性率。对于极端反应的预测，刺激的E-2水平的临床价值是中等的。
Purpose: In ovarian stimulation an exaggerated ovarian response is often seen and is related to medical complications, such as ovarian hyperstimulation syndrome (OHSS), and increased patient discomfort. If it were possible to identify hyperresponders at an early stage of the stimulation phase, adaptation of the stimulation protocol would become feasible to minimize potential complications. Therefore, we studied the usefulness of measuring stimulated serum estradiol (E-2) levels in predicting ovarian hyperresponse.Methods: A total of 109 patients undergoing their first IVF treatment cycle using a long protocol with GnRH agonist was prospectively included. The E-2 level was evaluated on day 3 and 5 of the stimulation phase. Two outcome measures were defined. The first was ovarian hyperresponse (collection of greater than or equal to15 oocytes at retrieval and/or peak E-2 > 10000 pmol/L, or cancellation due to greater than or equal to30 follicles growing and/or peak E-2 > 15000 pmol/L, or OHSS developed). The second outcome measure comprised a subgroup representing the more severe hyperresponders, named extreme-response (cancellation or OHSS developed).Results: The data of 108 patients were analyzed. The predictive accuracy of E-2 measured on stimulation day 3 towards ovarian hyperresponse was clearly lower than that of E2 measured on stimulation day 5 ( area under the receiver operating characteristic curve (ROCAUC) 0.75 and 0.81, respectively). For extreme-response the predictive accuracy of E-2 measured on stimulation day 3 or 5 was comparable (ROCAUC 0.81 and 0.82, respectively). For both outcome measures the stimulated E-2 tests yielded only acceptable specificity with moderate sensitivity at higher cutoff levels. Prediction of extreme-response seemed slightly more effective due to a lower error rate.Conclusions: There is a significant predictive association between E-2 levels measured on stimulation day 3 and 5 and both ovarian hyperresponse and extreme-response in IVF. However, the clinical value of stimulated E-2 levels for the prediction of hyperresponse is low because of the modest sensitivity and the high false positive rate. For the prediction of extreme-response the clinical value of stimulated E-2 levels is moderate.