Diminished ovarian reserve in the United States assisted reproductive technology population: diagnostic trends among 181,536 cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System.
Diminished ovarian reserve in the United States assisted reproductive technology population: diagnostic trends among 181,536 cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System.
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DOI：
10.1016/j.fertnstert.2015.05.017
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发表时间：
2015-09
影响因子：
6.7
通讯作者：
Propst A
中科院分区：
文献类型：
--
作者：
Devine K;Mumford SL;Wu M;DeCherney AH;Hill MJ;Propst A
评价SART CORS数据库中DOR分配的趋势，并评价其预测ESHRE 'Bologna标准'（2011）中定义的卵巢反应不良（POR）的准确性。回顾性队列研究。不适用因2004年和2011年（最早和最近可用的报告年份），美国诊所向SART报告了181，536个新鲜的自体ART周期。没有。DOR分配是主要暴露。POR定义为常规促性腺激素刺激（每日>149 IU FSH）后因反应不良或取卵<4个而取消周期，是主要结局。次要结局是活产和获卵数。还计算了DOR患病率、DOR和FSH（</≥12 mIU/mL）预测POR的能力以及POR周期中的活产。DOR患病率从2004年的19%上升到2011年的26%。在临床指定为DOR的周期中，POR发生率从32%降至30%，活产率从15%提高至17%。基础FSH ≥12与临床DOR比较，基础FSH和PPV预测POR的特异性较高（92.2%vs.81.6%和38.3%vs.30.9%）。POR周期中的活产率为4%。DOR的诊断正在增加，准确性仍然很差，尽管有额外的诊断参数，如窦卵泡计数和抗苗勒管激素。POR导致不良结局，但大多数临床分配为DOR的患者未发生POR。需要开发和利用更准确的POR预测因子，以最大限度地减少过度诊断导致的患者痛苦。
To evaluate trends in DOR assignment in the SART CORS database and to evaluate its accuracy in predicting poor ovarian response (POR) as defined in ESHRE’s ‘Bologna Criteria’ (2011). Retrospective cohort study. Not applicable. 181,536 fresh, autologous ART cycles reported to SART by US clinics in 2004 and 2011 (earliest and most recent available reporting years). None. DOR assignment was the primary exposure. POR, defined as cycle cancellation for poor response or <4 oocytes retrieved following conventional gonadotropin stimulation (>149 IU FSH daily), was the primary outcome. Secondary outcomes were live birth and number of oocytes retrieved. DOR prevalence, power of DOR and FSH (</≥12 mIU/mL) to predict POR, and live birth in POR cycles were also calculated. DOR prevalence increased from 19 to 26% from 2004 to 2011. Among cycles clinically assigned as DOR, incidence of POR decreased from 32 to 30%, and live birth improved from 15 to 17%. Comparing basal FSH ≥12 versus clinical assignment of DOR, basal FSH had a higher specificity (92.2% vs.81.6%) and PPV (38.3%vs.30.9%) for predicting POR. Live birth among POR cycles was 4%. DOR diagnosis is increasing, and accuracy remains poor, despite the availability of additional diagnostic parameters such as antral follicle count and anti-mullerian hormone. POR entailed poor outcomes, but the majority of patients clinically assigned as DOR did not experience POR. Development and utilization of more accurate predictors of POR are needed to minimize patient distress resulting from over-diagnosis.