Do ovarian endometriomas affect ovarian response to ovarian stimulation for IVF/ICSI?
Do ovarian endometriomas affect ovarian response to ovarian stimulation for IVF/ICSI?
复制标题
DOI：
10.1016/j.rbmo.2020.03.013
复制
发表时间：
2020-07-01
影响因子：
4
通讯作者：
Polyzos, Nikolaos P.
中科院分区：
文献类型：
--
作者：
Gonzalez-Foruria, Inaki;Barri Soldevila, Pedro;Polyzos, Nikolaos P.
研究问题：在调整年龄和卵巢储备标志物后，卵巢腺瘤的存在是否影响卵巢对卵巢刺激的反应？设计图：这项回顾性横断面研究比较了卵巢恶性肿瘤患者和有其他不孕因素的女性接受首次卵巢刺激进行IVF/卵胞浆内单精子注射（ICSI）的卵巢反应。两组均建立年龄特异性卵母细胞数诺模图模型，并在调整年龄、促性腺激素剂量、抗苗勒管激素（AMH）浓度和窦卵泡计数（AFC）后比较卵巢反应性。结果：共纳入923例患者：101例至少有一个卵巢恶性肿瘤，822例有其他不孕因素。对获得卵母细胞数量的列线图的比较表明，当结果根据年龄和获得卵母细胞数量的z分数进行调整时，（-0.49 +/- 0.71对比-0.20 +/- 0.86; 95%置信区间[CI] -0.47至-0.12）以及调整促性腺激素总剂量和AMH值后（z评分平均差异-0.338; 95% CI-0.54，-0.14）。当z评分调整促性腺激素剂量和AFC时，两组之间获得的卵母细胞数量相当（z评分平均差异-0.038; 95%CI-0.34至0.27）。结论：在调整年龄、促性腺激素剂量和AMH后，卵巢癌患者接受IVF/ICSI卵巢刺激后的卵巢反应显著低于对照组。卵巢癌患者卵巢刺激的剂量和方案选择应基于AFC而不是AMH，因为后者可能被高估。
Research question: Does the presence of ovarian endometriomas affect ovarian response to ovarian stimulation after adjusting for age and ovarian reserve markers?Design: This retrospective cross-sectional study compared the ovarian response between patients with ovarian endometriomas and women with other infertility factors undergoing their first ovarian stimulation for IVF/intracytoplasmic sperm injection (ICSI). An age-specific nomogram model for the number of oocytes retrieved was built for both groups, and ovarian response was compared after adjusting for age, gonadotrophin dose, anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC).Results: A total of 923 patients were included: 101 women with at least one ovarian endometrioma, and 822 patients with other infertility factors. Comparisons of the nomograms for the number of oocytes retrieved demonstrated that response was significantly lower for women with endometrioma when the results were adjusted for age the z-score for the number of oocytes retrieved (-0.49 +/- 0.71 versus -0.20 +/- 0.86; 95% confidence interval [CI] -0.47 to -0.12) and also after adjustment for the total dose of gonadotrophins and AMH values (z-score mean difference -0.338; 95% CI -0.54, -0.14). When the z-score was adjusted for gonadotrophin dose and AFC, the number of oocytes retrieved was comparable between the two groups (z-score mean difference -0.038; 95% CI -0.34 to 0.27).Conclusions: Ovarian response after ovarian stimulation for IVF/ICSI in women with endometriomas is significantly lower than in controls after adjusting for age, gonadotrophin dose and AMH. Dose and protocol selection for ovarian stimulation in patients with endometrioma should be based on AFC rather than AMH, as the latter may be overestimated.