经阴道三维超声联合抗苗勒管激素在卵巢储备功能评估中的应用价值
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摘要
目的探讨经阴道三维超声联合抗苗勒管激素(AMH)检测在卵巢储备功能评估中的应用价值。方法选取121例备孕女性,均在月经期第3天行经阴道三维超声检查,采用超声自动容积测量(SonoAVC)技术获取窦卵泡计数(AFC)、卵巢体积(OV)及卵巢基质动脉收缩期峰值流速(PSV),并同时检测与卵巢储备功能相关的基础性激素及AMH的绝对值水平。根据基础性激素水平正常与否,将备孕女性分为A组(正常组)与B组(异常组),再依据年龄进一步将A组分为A1组(年龄<40岁)和A2组(年龄≥40岁),将B组分为B1组(年龄<40岁)和B2组(年龄≥40岁)。研究分析4组间上述各项超声测量值、血液AMH值以及临床妊娠率和妊娠结局的差异性;分析AFC、OV及卵巢基质动脉PSV三者之间的相关性,以及三者与AMH的相关性;同时根据妊娠结局,将所有成功受孕女性分为妊娠结局良好组与不良组,比较2组间上述各项超声测量值及AMH之间的差异性。结果 4组备孕女性的AFC、OV及AMH差异均有统计学意义(F=12.572、5.862、15.194,P均≤0.001),A1组的AFC、OV、AMH显著高于B1和B2组,差异具有统计学意义(P均<0.05)。A1组的AFC显著大于A2组,差异具有统计学意义(P <0.05);A2组的AFC大于B2组,差异具有统计学意义(P <0.05);B1组的AFC显著大于B2组,差异具有统计学意义(P <0.05)。A2组的AMH显著高于B2组,差异具有统计学意义(P <0.05)。4组备孕女性卵巢基质动脉PSV差异无统计学意义(P> 0.05)。AFC与OV,AFC与AMH,OV与AMH均呈正相关(r=0.488、0.498、0.462,P均<0.001)。A1组临床妊娠率最高(22/51,43.14%),不良妊娠结局发生率最低(5/22,22.73%);B2组临床妊娠率最低(1/17,5.88%),且受孕女性妊娠结局不良。妊娠结局良好组的AFC、OV及AMH显著高于不良组(t=2.079、2.885、2.164,P均<0.05)。结论经阴道三维SonoAVC技术可简便、准确地获取AFC、OV等超声指标,联合血清AMH水平可为临床提供精准、可靠的量化指标,从而为卵巢储备功能的评估以及妊娠结局的预测提供重要的参考依据。
Objective To assess the value of transvaginal three-dimensional(3 D) ultrasound combined with anti-Müllerian hormone(AMH) in the assessment of ovarian reserve function. Methods One hundred and twenty-one women who were ready for pregnancy were selected, all of whom underwent transvaginal 3 D ultrasound on the third day of menstruation. The data of antral follicle count(AFC), ovarian volume(OV), and peak systolic velocity of the ovarian stromal artery(PSV) were collected by sonographybased automated volume calculation(Sono AVC). The levels of basic sex hormone and AMH, which are related to ovarian reserve function, were also detected. According to the level of basic sex hormone, the patients were divided into either group A(having a normal level of basic sex hormone) or group B(having an abnormal level of basic sex hormone). The two groups were further divided into two subgroups based on the age: < 40 yrs(subgroups A1 and B1) and ≥ 40 yrs(subgroups A2 and B2). The data of ultrasound,AMH, and pregnancy outcome among the subgroups were compared. The correlations among AFC, OV,and ovarian stromal artery PSV as well as their correlation with AMH were also analyzed. According to the pregnancy outcome, all the pregnant women were divided into a good pregnancy outcome group and a poor pregnancy outcome group, and the differences in the above ultrasound measurements and AMH between the two groups were compared. Results The four subgroups of women showed a statistical difference in AFC, OV, and AMH(F=12.572, 5.862, and 15.194, respectively; P ≤ 0.001 for all). The AFC, OV, and AMH in subgroup A1 were significantly higher than the those in subgroups B1 and B2(P < 0.05). The AFC was significantly higher in subgroup A1 than in subgroup A2(P < 0.05), in subgroup A2 than in subgroup B2(P < 0.05), and in subgroup B1 than in subgroup B2(P < 0.05). There was a positive correlation between AFC and OV, between AFC and AMH, and between OV and AMH(r=0.488, 0.498, and 0.462, respectively;P < 0.001 for all). Subgroup A1 had the highest pregnancy rate [22/51(43.14%)] and lowest poor pregnancy outcome [5/22(22.73%)]. Subgroup B2 had the lowest pregnancy rate [1/17(5.88%)] and a poor pregnancy outcome. The AFC, OV, and AMH in the good pregnancy outcome group were significantly higher than those in the poor pregnancy outcome group(t=2.079, 2.885, and 2.164, respectively; P < 0.05 for all).Conclusion Transvaginal 3 D ultrasound-based AVC can obtain AFC and OV easily and precisely.Combined with AMH, transvaginal 3 D ultrasound can provide objective, precise, and reliable data for ovarian reserve function assessment and pregnancy outcome prediction.
Objective To assess the value of transvaginal three-dimensional(3 D) ultrasound combined with anti-Müllerian hormone(AMH) in the assessment of ovarian reserve function. Methods One hundred and twenty-one women who were ready for pregnancy were selected, all of whom underwent transvaginal 3 D ultrasound on the third day of menstruation. The data of antral follicle count(AFC), ovarian volume(OV), and peak systolic velocity of the ovarian stromal artery(PSV) were collected by sonographybased automated volume calculation(Sono AVC). The levels of basic sex hormone and AMH, which are related to ovarian reserve function, were also detected. According to the level of basic sex hormone, the patients were divided into either group A(having a normal level of basic sex hormone) or group B(having an abnormal level of basic sex hormone). The two groups were further divided into two subgroups based on the age: < 40 yrs(subgroups A1 and B1) and ≥ 40 yrs(subgroups A2 and B2). The data of ultrasound,AMH, and pregnancy outcome among the subgroups were compared. The correlations among AFC, OV,and ovarian stromal artery PSV as well as their correlation with AMH were also analyzed. According to the pregnancy outcome, all the pregnant women were divided into a good pregnancy outcome group and a poor pregnancy outcome group, and the differences in the above ultrasound measurements and AMH between the two groups were compared. Results The four subgroups of women showed a statistical difference in AFC, OV, and AMH(F=12.572, 5.862, and 15.194, respectively; P ≤ 0.001 for all). The AFC, OV, and AMH in subgroup A1 were significantly higher than the those in subgroups B1 and B2(P < 0.05). The AFC was significantly higher in subgroup A1 than in subgroup A2(P < 0.05), in subgroup A2 than in subgroup B2(P < 0.05), and in subgroup B1 than in subgroup B2(P < 0.05). There was a positive correlation between AFC and OV, between AFC and AMH, and between OV and AMH(r=0.488, 0.498, and 0.462, respectively;P < 0.001 for all). Subgroup A1 had the highest pregnancy rate [22/51(43.14%)] and lowest poor pregnancy outcome [5/22(22.73%)]. Subgroup B2 had the lowest pregnancy rate [1/17(5.88%)] and a poor pregnancy outcome. The AFC, OV, and AMH in the good pregnancy outcome group were significantly higher than those in the poor pregnancy outcome group(t=2.079, 2.885, and 2.164, respectively; P < 0.05 for all).Conclusion Transvaginal 3 D ultrasound-based AVC can obtain AFC and OV easily and precisely.Combined with AMH, transvaginal 3 D ultrasound can provide objective, precise, and reliable data for ovarian reserve function assessment and pregnancy outcome prediction.
引文
1 Committee on Gynecologic Practice of American College of Obstetricians and Gynecologists;Practice Committee of American Society for Reproductive Medicine.Age-related fertility decline:a committee opinion[J].Fertil Steril,2008,90(3):486-487.
2 Kimberly L,Case A,Cheung AP,et al.Advanced reproductive age and fertility:no.269,November 2011[J].Int J Gynaecol Obstet,2012,117(1):95-102.
3 American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee.Female agerelated fertility decline.Committee Opinion No.589[J].Fertil Steril,2014,101(3):633-634.
4程炜,孙爱军.卵巢储备功能的研究进展[J].实用妇科内分泌杂志(电子版),2017,4(3):11-13.
5何淑明,梁丽霞.育龄期妇女阴道超声多普勒参数与卵巢储备功能的关系[J].广东医学,2013,34(10):1579-1580.
6 Deb S,Jayaprakasan K,Campbell BK,et al.Intraobserver and interobserver reliability of automated antral follicle counts made using three-dimensional ultrasound and SonoAVC[J].Ultrasound Obstet Gynecol,2009,33(4):477-483.
7 Raine-Fenning N,Deb S,Jayaprakasan K,et al.Timing of oocyte maturation and egg collection during controlled ovarian stimulation:a randomized controlled trial evaluating manual and automated measurements of follicle diameter[J].Fertil Steril,2010,94(1):184-188.
8 Deb S,Campbell BK,Clewes JS,et al.Quantitative analysis of antral follicle number and size:a comparison of two-dimensional and automated three-dimensional ultrasound techniques[J].Ultrasound Obstet Gynecol,2010,35(3):354-360.
9 Hernández J,Rodríguez-Fuentes A,Puopolo M,et al.Follicular Volume Predicts Oocyte Maturity:A Prospective Cohort Study Using Three-Dimensional Ultrasound and SonoAVC[J].Reprod Sci,2016,23(12):1639-1643.
10 Shmorgun D,Hughes E,Mohide P,et a1.Prospective cohort study of three-versus two-dimensional ultrasound for prediction of oocyte maturity[J].Fertil Steril,2010,93(4):1333-1337.
11毛书霞,强也,张玫玫,等.经阴道三维超声评价卵巢储备功能的临床价值[J].山东医药,2016,56(36):56-58.
12 Kofinas JD,Elias RT.Follicle-stimulating hormone/luteinizing hormone ratio as an independent predictor of response to controlled ovarian stimulation[J].Womens Health(Lond),2014,10(5):505-509.
13 Orvieto R,Meltzer S,Rabinson J,et al.Does day 3 luteinizinghormone level predict IVF success in patients undergoing controlled ovarian stimulation with GnRH analogues?[J].Fertil Steril,2008,90(4):1297-1300.
14 Lin PY,Huang FJ,Kung FT,et al.Evaluation of serum anti-mullerian hormone as a biomarker of early ovarian aging in young women undergoing IVF/ICSI cycle[J].Int J Clin Exp Pathology,2014,7(9):6245-6253.
15 Lambert-Messerlian G,Plante B,Eklund EE,et al.Levels of antimullerian hormone in serum during the normal menstrual cycle[J].Fertil Steril,2016,105(1):208-213.
16 Li HW,Lee VC,Lau EY,et al.Role of baseline antral follicle count and anti-mullerian hormone in prediction of cumulative live birth in the first in vitro fertilisation cycle:a retrospective cohort analysis[J].PLoS One,2013,8(4):e61095.
17 Dayal M,Sagar S,Chaurasia A,et a1.Anti-Mtillerianhormone:a new marker of ovarian function[J].J Obstet Gynecol India,2014,64(2):130-133.
18 Gibreel A,Maheshwari A,Bhattacharya S,et a1.Ultrasound tests of ovarian reserve:a systematic review of accuracy in predicting fertility outcomes[J].Hum Fertil(Camb),2009,12(2):95-106.
19 Practice Committee of the American Society for Reproductive Medicine.Testing and interpreting measures of ovarian reserve:a committee opinion[J].Fertil Steril,2015,103(3):e9-e17.
2 Kimberly L,Case A,Cheung AP,et al.Advanced reproductive age and fertility:no.269,November 2011[J].Int J Gynaecol Obstet,2012,117(1):95-102.
3 American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee.Female agerelated fertility decline.Committee Opinion No.589[J].Fertil Steril,2014,101(3):633-634.
4程炜,孙爱军.卵巢储备功能的研究进展[J].实用妇科内分泌杂志(电子版),2017,4(3):11-13.
5何淑明,梁丽霞.育龄期妇女阴道超声多普勒参数与卵巢储备功能的关系[J].广东医学,2013,34(10):1579-1580.
6 Deb S,Jayaprakasan K,Campbell BK,et al.Intraobserver and interobserver reliability of automated antral follicle counts made using three-dimensional ultrasound and SonoAVC[J].Ultrasound Obstet Gynecol,2009,33(4):477-483.
7 Raine-Fenning N,Deb S,Jayaprakasan K,et al.Timing of oocyte maturation and egg collection during controlled ovarian stimulation:a randomized controlled trial evaluating manual and automated measurements of follicle diameter[J].Fertil Steril,2010,94(1):184-188.
8 Deb S,Campbell BK,Clewes JS,et al.Quantitative analysis of antral follicle number and size:a comparison of two-dimensional and automated three-dimensional ultrasound techniques[J].Ultrasound Obstet Gynecol,2010,35(3):354-360.
9 Hernández J,Rodríguez-Fuentes A,Puopolo M,et al.Follicular Volume Predicts Oocyte Maturity:A Prospective Cohort Study Using Three-Dimensional Ultrasound and SonoAVC[J].Reprod Sci,2016,23(12):1639-1643.
10 Shmorgun D,Hughes E,Mohide P,et a1.Prospective cohort study of three-versus two-dimensional ultrasound for prediction of oocyte maturity[J].Fertil Steril,2010,93(4):1333-1337.
11毛书霞,强也,张玫玫,等.经阴道三维超声评价卵巢储备功能的临床价值[J].山东医药,2016,56(36):56-58.
12 Kofinas JD,Elias RT.Follicle-stimulating hormone/luteinizing hormone ratio as an independent predictor of response to controlled ovarian stimulation[J].Womens Health(Lond),2014,10(5):505-509.
13 Orvieto R,Meltzer S,Rabinson J,et al.Does day 3 luteinizinghormone level predict IVF success in patients undergoing controlled ovarian stimulation with GnRH analogues?[J].Fertil Steril,2008,90(4):1297-1300.
14 Lin PY,Huang FJ,Kung FT,et al.Evaluation of serum anti-mullerian hormone as a biomarker of early ovarian aging in young women undergoing IVF/ICSI cycle[J].Int J Clin Exp Pathology,2014,7(9):6245-6253.
15 Lambert-Messerlian G,Plante B,Eklund EE,et al.Levels of antimullerian hormone in serum during the normal menstrual cycle[J].Fertil Steril,2016,105(1):208-213.
16 Li HW,Lee VC,Lau EY,et al.Role of baseline antral follicle count and anti-mullerian hormone in prediction of cumulative live birth in the first in vitro fertilisation cycle:a retrospective cohort analysis[J].PLoS One,2013,8(4):e61095.
17 Dayal M,Sagar S,Chaurasia A,et a1.Anti-Mtillerianhormone:a new marker of ovarian function[J].J Obstet Gynecol India,2014,64(2):130-133.
18 Gibreel A,Maheshwari A,Bhattacharya S,et a1.Ultrasound tests of ovarian reserve:a systematic review of accuracy in predicting fertility outcomes[J].Hum Fertil(Camb),2009,12(2):95-106.
19 Practice Committee of the American Society for Reproductive Medicine.Testing and interpreting measures of ovarian reserve:a committee opinion[J].Fertil Steril,2015,103(3):e9-e17.