- TiJP CHl NGglEKi. C l f U Y HQC
OANH GIA KET QUA THU TINH TRONG ONG NGHIEM VA MOT s o YEU T 6 LIEN QUAN d BENH NHAN
DAP UNG KEM Vdl PHAC Dd ANTAGONIST
N g u y i n Xuan Hp-i^ Nguydn Manh Ha^
^B$nh vi$n Phij san Trung Wang, ^ Trw&ng d^i hoc Y Ha Noi Dinh gii ket qua thu tmh trong dng nghigm a bdnh nhin dap iing kem vdi phac dd antagonist vi mgt so yiu td liin quan ddn dap ung kem, sir dgng phwang phip nghien cOv hdi cCm trdn 1292 benh nhin thu tinh trong dng nghiem dwac kich thich budng triing bang phic dd antagonist, vdi tieu chuan dip Ung kem khi sd noin thu dwcfc £ 3 Nhdm benh nhan dip img kim ed ty le thg tmh: 76.2%; ty lg lam to- 11,2%.
ty lg thai lam sing. 22.2% B$nh nhin cd nang thif cip nhd hon hoie bing 4 cd nguy ca dap img kem gip lan 2.22 so vdi nhdm cd nang thir cap ldn han 4 (95%CI 1,44 - 3.42); bgnh nhin cd E2 ngiy hCG be han hogc bing 1000 pg/ml nguy ca dap img kdm cao gip 6,02 ian so vol nhdm Idn han 1000 pg/ml (95%CI- 3,36 - 10,78); bgnh nhan cd E2 ngiy 7 nhd han hoac bing 300 pg/ml thi nguy co dap wng kem cao gip 6,83 lin so vdi nhdm Idn hon 300 pg/ml (95%CI: 1,89 - 24,55;,- bdnh nhan cd FSH co bin ldn hon 10 lUA thi nguy ca dip ung kem cao gip 3,34 lin so vdi nhdm be han 10 lU/l (95%CI 1,77 - 6.37) Tip khoa: Thy tinh trong 6ng nghiem, antagonist, dap iJng kem, AFC, E2, FSH cc ban.
I. DAT V A N D ^
Ca hoi eho nhUng phy nir d^p irng kdm vdi kich thich budng trirng de ed thai b3ng noan cua minh thudng rlit Ih^p vi v$y cSu hoi dau tien du'oc dat ra cho cac b#nh nhSn nSy l^ c6 ndn ti^p tuc theo duoi ISm thy tinh trong ong nghifem hay khdng'' Mae dii c6 rcil nhi^u cac yeu to ndi tiet, sieu am vS cae test khSc nhau de dcinh giS dap irng cua buong tn>ng nhu'ng khdng ed y4u Id n^o ed the li&n lup'ng chinh xac duoc dSp irng vd-i kich thich budng trirng 6' ngu'di phy niJ eho tdi khi thyc hien chu ky IVF dau ti6n [1]. Mdt khd khan nu-a la mac dii dap irng kdm la mdt v^n de du'p'c du'a ra tir r i t lau nhu'ng c^c li6u c h u i n hay dong thu^n dua Dja chi lidn h$' Nguyen Mgnh Hi. Bd mdn Md hgc- Phdi thai hgc, trwdng Dgi hgc Y Hi Ngi Email: [email protected] Ngay nhan: 21/1/2017 Ngiy dwac chap nh$n: 26/6/2017
ra v i n cdn gay tranh cSi, vi v^y viec so sanh ket qua eua eae chidn luce dieu trj khac nhau eho nhdm ddi tu'O'ng nSy de tim ra bi^n ph^p toi uu la rat khd khan. Khai ni6m dap irng kdm thudng dya vao su kel hgp cSo y^u t6 nhu' s6 nang tri>ng truong thanh trong qua trinh kich thich buong trii'ng, sd luong no§n thu dugc, dinh estradiol. Oiem gidi hgn eho so luong no§n thu dugc de xac dinh d i p irng k6m eung rat khac nhau giua e^e nghign eu'u. Mot sd quan diem khSc I91 phSn loai dSp irng I6m dya tr6n ndng dd FSH co ban trudc khi kich thich bu6ng trirng Mpt vai t^c gia ung hp viec dua ti^n s u dap irng vd'i kieh thich trud-c dd v^o trong dmh nghTa eiia dSp ung k6m v^ so lugng noan it chi dugc chap nhan khi s u dung lieu eao FSH [2].
Khdng ehi khdng cd s y th6ng nhat ve li6u chuan chan do^n mS cdn khdng ed sy thdng
TCNCYH 108 (3)-2017
TAP C H I ^ H l E t i Q U ' U Y HQC nhat trong vi^c dua ra chien luge dieu trj cho nhdm benh nhan dap irng k6m Cd r l l nhieu cac phSc do khac nhau dugc dua ra nhung chua cd bang chii-ng nao thuyet phuc b i t eu phac do nao hieu qua hon trong thu tmh trong dng nghiem eung nhu cac y^u to anh hudng d i n dap irng kem dac bidt la d" nhij-ng phu nu"
tre tuoi [3]. Cac yeu to hen quan d i n dap ung bu6ng trung Kem da duoc ghi nhan bao gom tuoi, lugng FSH co ban, so lu'gng nang thu c i p , nong dd inhibin B, tugng AMH, estradiol ngSy 3 va t h i lich cua buong trirng. Mae dii nong dd FSH cd su dao ddng r i t 16'n trong chu ky kmh, FSH co ban v i n la y i u Id tien lugng hO-u ich [4]. Estradiol la y i u Id sang loe dap irng buong trirng kdm khi ket hgp vdi FSH [5]
Inhibin B do t i bao hat san xuat trong qua trlnh phat then nang noan va la xel nghigm danh gia tryc t i i p hogt ddng cua buong trirng [6].
So nang thu cap < 4 nang thi lign quan d i n dap ung kdm vdi kich thich buong tryng va cd ly 1$ hiiy bd chu ky cao hon, ed dac hieu 64% - 100% trong vigc dy doan kha nang cd thai [7]," AMH do t i bao hat san xuit trong qua trinh luyen chpn cac nang noan cho d i n khi cac nang noan nhay cam vdi FSH [8], la chi baoquan trpng de danh gia du IrD' buong tryng [9], luy nhign AMH khdng lign lugng duoc kha nangcdthai[10]
Tai Vigt Nam, cho tdi nay chua cd nghien cifu nao dugc thyc hign ve hidu qua thuc sy eua thy tinh trong dng nghiem va cac y i u to lien quan trgn nhdm bgnh nhan dap urig kgm vdi phac do antagonist, Vi vgy, nghien cuu nay dugc thuc hign nham d^nh gia k i t qua eiia thy tinh trong ong nghiem trdn nhO-ng bgnh nhan dap ung kem vdi phac do antagonist va tim hieu m0t s6 yeu to lign quan den dap ung kem.
II. D 6 | TU'aNG VA PHU'O'NG PHAP
1.£)di tu'O'ng
Ddi tugng nghign cuu la cac trudng ti^p iam Ihy linh trong i n g nghigm dap yng kem vdi phac a i antagonist vd'i tieu chuan dap dap i>ng kgm khi thu dugc khdng nhieu han 3 noan,
Logi tru cac trud'ng hop eho nhgn noan.
2. Phu'O'ng phap
Md la h i i cuu, cae benh nhan duoc kich thich buing trung bang phac dd antagonist, theo ddi sy phai tnen cua nang noan khi c6 it nhit 1 nang cd kich thude > 14 mm bit dau tiem antagonist, liem hCG khi cd it nhat 2 nang c6 kieh Ihudc > 18 mm T i i n hanh hiJt noan sau tigm hCG 34 - 36 gid Sau dd tien hanh thg tmh bang phuang phdp IVF/ICSI. Chuyen phoi vao ngay thy 2 - 3 sau hut noin. Hd tro hoang the sau chuyen phdi Thu p-hCG sau 14 ng^y chuyen phdi va sieu am d i u dd am dao sau 28 ngay chuyen phdi
Mdt s i ehi lidu nghien cuu:
+ T'y le dip u'ng k6m = T i n g s i bgnh nhan cd noan < 3 / t i n g s i bgnh nhan kich thich budng tryng (KTBT) bang phac d i antagonist So noan duae linh b i n g long so noan Mil thu dugc sau choc hiit
+ Ty lg Ihu tmh _= T i n g s i noan thy tinh / ,t6ng so noan thu dugc. Noan Ihu tinh du'oc xac dinh b i n g hgp t u cd 2 tien nhan 6' khoang thdi gian 16 - 1 8 gid sau ky thu^t ICSl
+ Ty le l^m td = Tong so tiii thai / ting s6 phdi chuyin.
+ Thai lim sang. Sieu am thiy 1 hay nhi^u till thai trong buong tCr eung
Ty Ig thai lam sang = Tong s i chu ky cdtul thai / long so chu ky chuyen phdi,
Cac sd ligu dugc thu thgp dya tren benh an cOa cac bgnh nhan thu tmh trong dng nghiem tai Trung tSm Ho trg smh san Q u i c gia, lu'u triJ' va xir 1;^ b i n g phan m i m Slala, tinh cac ti suit chenh OR, khoang tin cay Cl va gia In p 3. Oao du'c nghien eu'u
aAP.QHl NGHiiN eu'u Y Hpc
Day la nghign cyu hdi ciru trgn eae bgnh ddi luong nghign ciru Cac thdng tm vg ngud'i an ciia ngudi bgnh dS dugc dieu tri tgi bgnh bgnh deu dugc gii> bi mat ehi phuc vu cho mue vign ngn khdng ed b i t cir can thigp nao vao dich nghidn cuu.
III. K^T QUA
Nghien ciru dugc thyc hign trgn 1262 bgnh nhan dugc kich thich buong tryng b i n g phgc d i antagonist tai Trung tam hd tra smh san Qudc gia, cd 186 bgnh nhgn dap yng kgm.
Bang 1. Ket qua thu tinh va phot 6' nhom dap ii'ng kem K i t qua thu tinh va phoi Gia trj S i noan thu duac 2,23 ± 0.74
1 18,8%
2 39,8%
3 41.4%
Sd noan thu linh So phdi S i phdi chuyen Ty le thu tinh
1,77 ± 0,98 1,72 ±1,00 1,68 ± 1,00
76.23%
Bang 1 the hien k i t qua thu tmh va phdi a cac benh nhan dap yng kdm vdi phae dd antagonist So bgnh nhan ed s i noan choc hiit ra t(y 2 den 3 noSn chiim ty Ig han 80%, Trong qua trinh thu thap sd ligu ghi nhan vai trudng hgp khdng ed noan nhung sau dd benh nhan tu nguyen xin noin ngn khdng n i m Irong d i i tuang nghien cyu cua chiing tdi. So noan thu tinh trung blnh la 1,77 + 0,98, s i phdi trung binh la 1,72 ± 1. S6 phdi chuyen trung binh la 1,68 ± 1, Trong 186 benh nhan dap yng kem cd 162 trud'ng hap ed phdi chuyin, 24 trudng hgp khdng chuyen phdi do khdng c6 phdi chuyen ho^c phdi bi thoai hda. Ty Ig thu tinh la 76,23%,
Bang 2. Ty le lam td va ty le c 6 thai lam sang a nhom dap ii'ng kem Ty le Gia tri
T y l g i a m t o 11'2%
Tong so tdi thai 35 Tong s i phdi chuyin 313 Ty Ig cd thai lam sang
Ty Ig da thai Mdt thai
Song thai ^°^'' 94%
TCNCYH 108 (3)-2017
TAP CHi NGHliacU'lJ Y HQC
Trong tong so 313 phoi chuyen, chi c6 35 phoi 14m to, dat ty 1611,2%. Tt 1$ co thai 14m sang la 22,22%. Trong so cac b$nh nhan c6 thai thi 94% bjnh nhSn cd mot thai, 6% b$nh nhan mang thai doi, kh6ng co tru'frng hc?p nao co tiK 3 thai tra ien Su^ac ghi nh^n (bang 2).
Bang 3. Ty le c6 thai lam sang theo s6 phoi chuyen o- nhom dap ii'ng kem Sd phoi chuyln
1 2 2 Tong so
Co thai 5 30 35
Khong co thai 54 73 127
OR 4,44
95%CI 1,6-12,2
P 0,002
Trong 59 bgnh nhgn cd 1 phdi chuygn, chi ed 5 bgnh nhan ed thai. Vdi viec chuyin 2 phdi, co 30 bgnh nhgn cd thai tren tong so 103 benh nhan Nhu vay, ty Ig cd thai khi chuyin > 2 phdi cao gap 4,44 l i n so vdi chuyen 1 phdi {95%CI; 1,6 -12.2) {bang 3)
Bang 4. Phan tich hdi quy da biin lien quan vd'i dap u'ng kem cua budng tru>ng
Cac y l u t6 lien
Tuoi
quan
<40
>40
> 4
< 4
<10
>10
>300
£300
> 1000 S1000
OR 1 1,21
1 2,22
1 3,34
1 6,83
1 6.02
Dap ijng kem
Khoang tin cay 95% (Ci)
0,68-2,15
1,44-3,42
1,77-6,37
1,89-2455
3,36-10,78
Theo bang phan tich hdi qui da bien bgnh nhan ed so nang thu cap nho han 4 c6 nguy ca dgp ung kdm gap 2,22 l i n so vai nhdm cd nang thy cap trgn 4 nang (95%CI 1,44 - 3,42) Bgnh nhan cd FSH ngdy 3 trgn 10 IU/1 nguy co dap i>ng kem 3,34 l i n so vdi nhdm nho han 10 lU/l (95%C1: 1,77 - 6,37), Bgnh nhgn cd E2 ngay 3 £ 300 pg/ml cd nguy co dap yng kgm so vdi nhdm Ion hon 300 pg/ml la 6,83 l i n
(95%CI: 1.89 - 24,55). C u i i eCing la bdnh nhSn c6 E2 ngay tigm HCG < lOOOpg/ml cd nguy co dap yng kem 6,02 lan so vdi nhdm tren 1000 pg/ml (95%C1 3,36-10,78).
IV. BAN LUAN
K i t qua thy tinh trong i n g nghigm d bSnh nhan dap (tng kdm vdi phac do antagonist
Nhdm ddi tugng dap ung kem vdi kich
-^^m^\ NGHIENCUIJ Y HOC thich budng Iryng la nhdm benh nhgn dac biet
cua thu tmh trong ong nghigm vl d nhung benh nhan nay thu dugc s i noan it, ed it phdi, tf Ig huy ehu k j cao vl vgy kdo theo ty lg cd thai ISm sang thap. Trong 186 bgnh nhan dap ii'ng kgm vdi phac d i antagonist cd 162 bgnh nhgn ed phdi chuyen, 24 bdnh rihan cdn lai khdng cd phdi chuyin do noan khdng thg tinh, hay phdi thoai hda. S i noan thu linh trung blnh lg 1.77
±0,98, s6 phdi trung blnh la 1.72 ± 1, so phdi chuyen trung binh la 1,68 ± 1,00.
Nghign cuu tren doi tugng dgp ung kem nhung ty lg thu linh cua chiing tdi eung kha eao 76,23%. Nghign ciru trgn ngud'i Trung Q u i c cho thiy ty lg thy tinh cua nhdm dap itng kdm thip hon nhdm dap ung blnh thud'ng (71% so vdi 86%) [11]. Ty lg thu tinh khac nhau giua cac phac dd, gi&a nhdm bdnh nhan dap yng kgm va khdng dap ung kem. Tuy nhien, ty lg thu tmh cdn phy thugc vao ky thuat igc rCra lua chpn tinh trting va ky thuat tiem tinh IrCing vao bao tuang noan.
Ty Ig |gm to phan gnh c h i t lugng phdi d i phdi cd the phat then thanh tui thai va c h i t luang nigm mac tir cung tiep nhan s u phat trien cua phdi. Ty le lam lo trong nghien eiru ciia chiing tdi la 11,2%, cao han nghien cyu cua Saykham nam 2013 a phac d i nglin (9,19%) va t h i p han a phac do dai (11,96%) Nghien cyu tai Bdnh vign Phu San Trung uang nam 2010 cho thiy tren bgnh nhan tre < 35 tuoi thi ty lg lam to la 15,4% [12], trong khi ty lg lam to cua nhom bgnh nhan > 40 tuoi la 6,65%. Nhu vgy ty le iam to khac nhau khdng nhieu giija cac phdc d i kich thich budng trirng, nhung cd sy khgc nhau rd rgt gi&a nhdm tuoi cao va nhdm tuoi thap.
Trong nghign ciru nay ly le ed thai lam sang la 22,22%). Ty le thai lam sang tren t i t oa cac d i l tuang thg tinh trong i n g nghigm tai nghign cuu lai Bgnh vign Phu San Trung Uang nam
2010 la 40% cao han r i t nhieu nghign cyu cua chiing ldi [12]. Nghign cyu tgi Trung Q u i c cho thay ly Ig od thai ISm sang cua nhdm bgnh nhan dgp i^ng kem vdi lidu chuan £ 3 noan ta 14.8%, cua nhdm dgp yng binh thudng la 36,7% [11] Rd rang dap ung kem anh huang r i t Idn d i n k i t qua thai Igm sang Ty Id cd thai eua nhdm dap ung kgm cdn lidn quan d i n t u i i , BlVll, n i n g do FSH ca ban. s i noan thu duac [13] Ty Ig ed thai cung thap han d' nhirng bgnh nhan dap yng kgm cd tuoi Idn hon so vdi nhung benh nhan dap yng kem nhung cdn tre (1,5-12,7% so vdi 13 - 35%). Khi xem xgt m i l tuang quan giya ty lg cd thai lgm sang va s6 phdi chuyin thi ly le ed thai khi chuyen > 2 phdi cao gap 4,44 l i n khi chuyen 1 phdi (95%CI;
1,617-12,186). C h i t luang phdi anh huang rat ldn d i n kha nSng cd thai, Bgnh nhan chi cd 1 phdi thi khdng cd ea hdi lua chon phdi t i t trudc khi chuyen. Mat khac nhyng trudng hap mdt phdi ndy lai thudng la phdi x i u ngn lgm giam ty Ig cd thai NhOng trudng hap cd 2-3 phdi thi ty lg cd phdi tot cao han nen ty le ed thai cQng se cao han.
cac y i u to hen quan den dap yng kem vdi kieh thich budng trung b i n g phac dd antagonist Cd r i t nhieu y i u t i tien lugng dap yng kem cd ty trudc khi b i t d i u kich thich buing tryng da dugc r i t nhiiu nghign cyu bao cao nhu tuoi
> 35, FSH ngay 3 tang > 10 lU/L, s i nang noan thir cap < 4 nang, inbibin B < 45 pg/ml, AMH <
25 pg/ml. Nghien ciru cua chOng tdi khao sat mdt s i yeu to hen quan d i n dap irng kem bao gdm t u i i , AFC. FSH ngay 3, E2 ngay 7 va E2 ngay tiem hCG
TUOI la yeu t i xac dinh manh me kha nang sinh san trong'chu ky l y nhien va cdc chu ky hd trg smh san, bdi vi tuoi la mot trong nhung y i u t i tign lugng d u tru cua budng tryng. Tuoi cang eao thi d u trLr buing tryng cang giam vg kha nang sinh san cang giam Trong nghign
TCNCYH 108 (3)-2017
JAP^HiyeHjEricyiuyiHQC
ciru eCia ehiing tdi eOng cho thiy cd su chgnh Igch giUa hai nhdm tuoi dudi 40 va 40 luoi trd len mac dii chi cd ^ nghTa lam sang khdng cd )/ nghla thing kg Dgy duac giai thich ring chijng tdi cht nghidn cyu trgn mgt phac do antagonist mg each chi dinh diing phae do cdn chua dugc thong nhit, C6 bgnh nhgn 49 tuoi dy try budng tryng r i t kgm. AFC = 0 da dugc l u v i n xin nogn nhung bgnh nhan van nhit quyet cam doan sCr dung phac dd kich tryng.
Van de tuoi > 40 lign quan d i n dgp trng kgm nhung khdng phai t i t ca, chinh vl vay luoi cQng ehi la mgt trong 3 ti6u chuan danh gia dgp yng cua d i n g thugn ESHRE 2011.
Nang thir c i p (AFC): Trong nghign ciru cCia chiing ldi bdnh nhan cd s i nang thy c i p
£ 4 thi kha ngng dap ung kem g i p 2,22 lan so vdi benh nhan cd > 4 nang AFC, Theo ESHRE 2011 sd nang thy c i p < 5 - 7 cQng la ligu chuan ehan dogn dgp yng kem. S i lugng nang thy c i p tidn luang s6 lugng noan khdng tign lugng kha nang cd thai vi kha nang cd thai khdng chi phy thugc vao so lugng noan ma cdn phu thugc vgo chat luang noan.
Ham luang FSH nggy 3: Phan tich hoi qui logistic da b i i n FSH ngay 3 (cCing vdi cac y i u to tuii, AFC, E2 nggy 7 va E2 ngay hCC) vd'i diem cut-off 10 lU/l trong nghien cuu nay Chung tdi thiy ring nguy co dgp yng kdm cua nhdm > 10 lU/l g i p 3,34 l i n nhdm 5 10 lU/l cd y nghla thing kg FSH nggy 3 la nong dO FSH ca ban trudc khi kich thich buong tryng. Day ia yeu to tham khao d y dogn lieu rFSH ban d i u , Ning dd FSH ca ban ia y i u t i huu ich trong dy doan dap ung eiia buing Iryng: FSH ngay 3 > 121U/1, dgc bigl > 20IU/I Ihl dap yng kgm kich thich buong tryng, N i u FSH nggy 3 a 25 lU/l hogc ngudi phy nO' tren 44 tu6i thi ca hdi cd thai g i n bang khdng khi kich Ihlch buing trung hogc hd tra sinh san [14],
Ham lugng E2: E2 nggy 2 < 300 pg/ml cd
nguy co dgp ieng kgm so vdi nhdm ldn hon 300 pg/ml la 6,83 Ian. E2 ngay tigm hCG s 1000 pg/ml cd nguy ca dgp yng kdm 6,02 liln so vdi nhdm trgn 1000 pg/ml, Mgc dii nong ao E2 ed t h i s u dyng nhu la chi d i u d i danh gia dap ii'ng b u i n tryng, nhieu nghidn ciru cho ring day chi lg 1 yeu t i hd tra them, dSc bift khi phoi hap vdi FSH ca ban [7],
Ngoai eae y i u to ve tuoi, s i nang thi> cap, so nogn thu dugc tien luang dgp yng k6m vdi kfch thich budng tryng, hien nay 1 chl so dugc dung pho b i i n de lign lugng kha nSng dgp yng vdi kich thich buing tryng la AMH (anli mullerian hormone). AMH dugc tiet ra boi cgc te bgo hgt cua nang noan nguyen thuy vS cd lign quan tryc tigp vdi s i lugng nang no3n nguyen thuy. AMH lg y i u t i dgnh gia du' trii' buong tryng vg la y i u t i tidn lugng dgp irng kgm buing tryng AMH khdng thay doi trong suit chu ky kinh nguygt, giam d i n theo tu6i.
Vi vgy dijng AMH dgnh gia du tru buing trirng thugn tign han so vdi FSH trudc day ChOng tdi mong muon ring xet nghiem AMH se du-pc tnen khai rdng rai han a cac trung tarn hd tstf sinh san Viet Nam
V. K^T LUAN
cae bgnh nhan dgp yng kdm su dyng phic do antagonist vdi kich thich buong trirng cO ti le thy tinh 76,2%, ty lg lam to 11,2% va ty I?
thai lgm sgng 22,2. So nang thu c i p < 4, lu'gng FSH ca ban > 10 lU/l, E2 ngay 7 < 300 pg/ml, E2 ngay tigm hCG £ 1000 pg/ml lg nhung yiu t o e d gia trj tign lugng trong dap irng kgm vSi phgc d i antagonist,
Lai cam an
Chimg tdi xin chan thanh cam an su dong y tham gia nghign cyu eua bgnh nhgn, cOng nhu sy giiip d& nhigt tinh cua cgc bgc sT, dieu dud'ng, k j thugt vign lai Trung tam h i tra sinh san Quoc gia
TAI LIEU THAM K H A O
1. Bancsi LF, Broekmans FJ et al (2002) _ Predictors of poor ovanan response in in vilro fertilization, a prospective study companng basal markers of ovanan resen/e. Fertil Stent 7 7 , 3 2 8 - 3 3 6 .
2. Kailasam C, Keay SD, Wilson P et al (2004), Defining poor ovarian response dunng IVF cycles, in vi/omen < 40 years, and its relationship vi/ith treatment. Hum Reprod. 19, 1544-1547
3 Tarlatzis BC, Zepirldis L, Grimbizis G et al (2003) Clinical management of low ovarian response to stimulation for IVF: a systematic revievif. Hum Reprod. 9. 61 - 73.
4. Jayaprakasan K, Campbell B, Hopkisson J et al (2008). Establishing the intercycle variability of three-dimensional ultrasonographic predictors of ovarian reserve Fert//Sfer//. 9 0 . 1 2 6 - 2 1 3 2 .
5 Evers JL, Slaats P, Land JA et al (1998) Elevated levels of basal estradiol-17beta predict poor response in patients vi'ith normal basal levels of follicle-stimulating hormone undergoing in vitro fertilizahon Fertil Steril 69, 1010-1014.
6 Scott RT (2001). Evaluation and treatment of the low responder patient Textbook of assisted reproductive techniques.
527 - 542.
7. Practice Committee of the American Society for Reproductive Medicine (2015).
Testing and interpreting measures of ovanan
TfliP CHtNGHIEN CCFU Y HQC reserve, a committee opinion. Feriil Steril. 103, e 9 - e 1 7 .
8 Hsueh A, Kawamura K, Cheng Y et al (2015). Intraovarian Control of Early Folliculogenesis EndocrRev. 36, 1 - 2 4
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TCNCYH 108 (3)-2017
TAP CHI NGHIEN eu'u Y HQC
Summary
OUTCOMES OF IN VITRO FERTILIZATION IN POOR OVARIAN RESPONSE WOMEN TREATED
BY GNRH ANTAGONIST THERAPY
The aim of this study was to determine the outcomes of in vitro fertilization {iVF} among poor ovanan response women treated by GnRH antagonist therapy and to evaluate predictive factors for poor ovanan response. This descriptive study carried out on 1292 IVF women undergone antagonist treatment, with poor response defined as s 3 oocytes retrieved. The resuit showed that, among the poor response women, fertilization rate 76.2%; implantation rate' 11.2%; clinical pregnancy rate, 22.2%. The adjusted odds ratio (OR) of having a poor ovanan response based on AFC < 4 was 2 22 (95%CI: 1.44 - 3.42), and based on E2 on the trigger day < 1000 pg/ml was 6.02 (95%CI: 3 36 -10.78), E2 on day 7 < 300 pg/ml was 6.83 (95%CI: 1.89 • 24 55), and basal FSH >10 was 344 (95%CI: 1.77-6.37).
Keywords: IVF, antagonist, poor ovarian response, AFC, E2, basal FSH
