【作者】 王浩；

【导师】 吴梅；

【作者基本信息】 山东大学 ， 影像医学与核医学（专业学位）， 2023， 硕士

【摘要】 目的研 究 接 受(In vitro fertilization/Intracytoplasmic sperm injection,IVF/ICSI)治疗的单侧卵巢子宫内膜异位囊肿患者,应用卵巢子宫内膜异位囊肿相对体积比(Ovarian Endometriomas relative volume,OERV)预测其卵巢反应性的能力及相关性,探讨其临床应用价值。方法回顾性分析自2018年1月至2022年8月期间,于山东中医药大学附属医院生殖与遗传中心接受IVF/ICSI治疗的共96例单侧卵巢子宫内膜异位囊肿不孕症(Ovarian endometriomas,OMAs)患者的临床及影像学资料。所有患者均行经阴道超声检查,并详细记录观察结果。计算OMAs的相对体积比OERV,OERV指的是OMAs体积与含有此OMAs的受损卵巢体积比值。入组96例患者依据 OERV 值分为三组,OERV<30%组(1 组,n=32),OERV≥30%且<50%组(2 组,n=32),OERV≥50%组(3 组,n=32)。通过分析接受 IVF/ICSI 治疗的患者周期基础资料及周期特征、结局等临床资料,比较使用预测卵巢反应的相关预测因子(AntiMiillerian hormone,AMH)、(Antral Follicle Coun,AFC)、(Follicular output rate,FORT)、优势卵泡数、获卵数、优胚数等来评估OERV作为单侧OMAs患者超声参数预测卵巢反应性的潜力。分析OERV与相关预测因子的相关性。结果(1)3组间在AMH、bFSH、受损卵巢AFC、对侧健康卵巢AFC、受损卵巢FORT、卵巢刺激方案、Gn天数、Gn总量、HCG日E2、总获卵数、2PN数、优胚数比较差异均无统计学意(P>0.05),受损卵巢获卵数比较差异有统计学意义(P<0.05)。(2)3组受损卵巢与对侧健康卵巢AFC 比较差异无统计学意义(P>0.05)。(3)OERV<30%组受损卵巢与对侧健康卵巢FORT、获卵数比较差异无统计学意义(P>0.05),成熟卵泡数是减少的(4.6±2.5 vs 6.3±3.0,P=0.023)。(4)OERV≥30%且<50%组受损卵巢与对侧健康卵巢相比FORT显著降低(41.4%vs 57.3%,P=0.002),成熟卵泡数显著减少(4.9±3.1 vs 6.9±3.6,P=0.007),获卵数减少(4.9±2.5 vs 7±3.3,P=0.004)。(5)OERV≥50%组受损卵巢比对侧健康卵巢FORT显著降低(41.4%vs 57.3%,P=0.002),成熟卵泡显著减少的(3.5±2.2 vs 6.3±3.2,P=0.000),获卵数显著减少(3.3±2.1 vs 6.9±3.4,P=0.000)。(6)OERV 与 AMH、总获卵数、2PN 数相关性没有统计学意义(P>0.05),OERV与受损卵巢获卵数呈负相关关系(r=-0.284,P=0.005)。结论单侧OMAs不孕患者可以使用超声参数OERV作为预测卵巢反应性的指标,OERV值30%作为预测受损卵巢反应性降低的截断值,但是OERV值的大小并不影响整体卵巢反应性和卵子质量。更多还原

【Abstract】 ObjectiveTo study the ability and correlation of ovarian endometriomas relative volume ratio(OERV)to predict ovarian responsiveness in patients with unilateral ovarian endometriomas undergoing(In vitro fertilization/Intracytoplasmic sperm injection,IVF/ICSI)treatment,and to explore its clinical application value.Materials and MethodsA retrospective analysis of the clinical and imaging findings of 96 infertile patients with unilateral ovarian endometriomas who received IVF/ICSI treatment in the Reproductive and Genetic Center of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2018 to August 2022 material.All patients underwent transvaginal ultrasonography,and the observations were recorded in detail.The relative volume ratio OERV of OMAs was calculated,and OERV refers to the ratio of the volume of OMAs to the volume of the damaged ovary containing the OMAs.The 96 patients enrolled were divided into three groups according to the OERV value,OERV<30%group(group 1,n=32),OERV≥30%and<50%group(group 2,n=32),OERV≥50%group(group 3,n=32).By analyzing the basic cycle data,cycle characteristics,outcome and other clinical data of patients receiving IVF/ICSI treatment,and comparing the use of relevant predictors(AntiMiillerian hormone,AMH),(Antral Follicle Coun,AFC),(Follicular output rate,FORT),AMH,AFC,FORT,number of dominant follicles,number of retrieved eggs,number of good embryos,etc.to predict ovarian response to evaluate Potential of OERV as an ultrasound parameter to predict ovarian responsiveness in patients with unilateral OMAs.The correlation of OERV with relevant predictors was analyzed.Results(1)AMH,bFSH,damaged ovary AFC,contralateral healthy ovary AFC,damaged ovary FORT,ovarian stimulation program,Gn days,Gn administered,HCG day E2,the number of total oocytes retrieved,2PN,top-quality embryos,There was no significant difference among the three groups(P>0.05),but there was a statistically significant difference in the number of oocytes retrieved from the damaged ovary(P<0.05).(2)There was no significant difference in AFC between the damaged ovary and the contralateral healthy ovary in the three groups(P>0.05).(3)There was no significant difference in the number of follicles retrieved and FORT between the damaged ovary and the contralateral healthy ovary in the OERV<30%group(P>0.05),but the number of mature follicles was reduced(4.6±2.5 vs 6.3±3.0,P=0.023).(4)In the OERV≥30%and<50%group,compared with the contralateral healthy ovary,FORT was significantly lower in the damaged ovary(41.4%vs 57.3%,P=0.002),and the number of mature follicles was significantly decreased(4.9±3.1 vs 6.9±3.6,P=0.007),and the number of oocytes retrieved decreased(4.9±2.5 vs 7±3.3,P=0.004).(5)In the OERV≥50%group,the FORT of the damaged ovary was significantly lower than that of the contralateral healthy ovary(41.4%vs 57.3%,P=0.002),and the mature follicles were significantly reduced(3.512.2 vs 6.3±3.2,P=0.000),the number of oocytes was significantly reduced(3.3±2.1 vs 6.9±3.4,P=0.000).(6)There was no significant correlation between OERV and AMH,the total number of oocytes retrieved,and 2PN(P>0.05),and there was a negative correlation between OERV and the number of oocytes retrieved in damaged ovaries(r=-0.284,P=0.005).ConclusionInfertility patients with unilateral OMAs can use the ultrasound parameter OERV as an index to predict ovarian responsiveness,and the OERV value of 30%is used as a cut-off value for predicting the reduced responsiveness of the damaged ovary,but the size of the OERV value does not affect the overall ovarian responsiveness and embryos quality.更多还原