Hum Reprod. 2011年9月19日 (搶鮮版)

出處:第二名的不孕症期刊

檢查基礎血液FSH反應卵巢庫存與試管嬰兒妊娠的產科負面結局的風險之間的關係

來自美國北卡羅萊納大學教堂山分校的研究

摘要

背景

試管嬰兒治療不育症可能與早產（PTB）及低出生體重（LBW）的發病率較高的風險。我們的目的是檢查是否檢查卵巢基礎血液FSH反應卵巢庫存與PTB和LBW之間從 IVF治療.的關係。

方法

導致懷孕的風險，輔助生殖技術數據庫，包括所有的婦女經歷了一個新鮮的非捐卵的IVF治療 ，一個在2008年美國國IVF週期產生一個單胞胎回顧性世代研究，每個病人有一個記錄的基礎血清FSH值（N = 14 262）的記錄。使用的FSH值是最大的基底或克羅米芬刺激的血清水平。登錄二項式模型的建立是為了評估協會之間的FSH和PTB（<37週），與 FSH和低出生體重（<2500克），產婦年齡調整後，種族，孕/校驗，早產過，吸煙，BMI和嬰兒gender.

結果

Data 14 086例患者進行了分析。 FSH水平和低出生體重的危險呈負相關。 FSH水平最高四分位數（≥9 MIU / ml）的婦女最高的調整，平均孕週（271.2天），最低調低出生體重 [0.87，95％的信心區間（CI）的相對危險度（RR）：0.76 1.01，最高的調整後的平均出生體重（3249克）和最低調整 RR低出生體重（0.89，95％CI：0.73-1.04）。

結論

最大的基礎 FSH水平和單胎試管嬰兒妊娠早產（PTB）及低出生體重（LBW）的危險呈反比關係。表明，卵巢儲備減少是不是試管嬰兒妊娠早產（PTB）及低出生體重（LBW）的肇因。

陳醫師的Comment:

卵巢庫存與試管嬰兒妊娠的產科負面結局的風險之間的關係似乎不大，年輕者(<38歲)即使AMH低，FSH高表現卵巢庫存低應不致於影響產科負面結局。高齡者(>40歲)則回歸自然法則。

Hum Reprod. 2011 Sep 19. [Epub ahead of print]

Examining the relationship between ovarian reserve, as measured by basal FSH levels, and the risk of poor obstetric outcome in singleton IVF gestations.

Calhoun KC, Fritz MA, Steiner AZ.

Source

Department of Obstetrics and Gynecology, Division of REI, University of North Carolina at Chapel Hill, 4001 Old Clinic Building, CB 7570, Chapel Hill, NC 27599-7570, USA.

Abstract

BACKGROUNDThe higher prevalence of preterm birth (PTB) and low birthweight (LBW) following infertility treatment may relate to the treatment itself or indicate that subfertility predisposes to a higher risk. Our aim was to examine whether basal FSH levels are related to the risk for PTB and LBW among pregnancies resulting from IVF.METHODSWe studied a retrospective cohort in the 2008 National Society for Assisted Reproductive Technology Database, including all women who underwent a fresh non-donor IVF cycle resulting in a singleton live birth having a recorded basal serum FSH value (n = 14 262). The FSH value used was either the maximum basal or clomiphene-stimulated serum level. Log binomial models were created to assess the associations between FSH and PTB (<37 weeks), and between FSH and LBW (<2500 g), adjusting for maternal age, ethnicity, gravidity/parity, history of PTB, smoking, BMI and infant gender.RESULTSData for 14 086 patients were analyzed. FSH levels were inversely related to the risk of PTB and LBW. Women in the highest quartile of FSH levels (≥9 mIU/ml) had the longest adjusted mean gestational age (271.2 days), the lowest adjusted relative risk (RR) of PTB [0.87, 95% confidence interval (CI): 0.76-1.01], the highest adjusted mean birthweight (3249 g) and the lowest adjusted RR of LBW (0.89, 95% CI: 0.73-1.04).CONCLUSIONSThe inverse relationship between maximal basal FSH levels and the risk for PTB and LBW in singleton IVF gestations suggests that diminished ovarian reserve is not the primary mediator of the increased prevalence of PTB and LBW in IVF pregnancies.