Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Клинико-анамнестические факторы риска развития «бедного» овариального ответа в программах вспомогательных репродуктивных технологий
Клинико-анамнестические факторы риска развития «бедного» овариального ответа в программах вспомогательных репродуктивных технологий
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Целью ретроспективного исследования «случай–контроль» было изучение клинико-анамнестических факторов риска и влияния разных способов стимуляции овуляции на развитие «бедного» овариального ответа и исходы программ вспомогательных репродуктивных технологий. На основании критериев Европейского общества репродукции и эмбриологии человека (ESHRE, 2011) 150 пациенток, проходящих лечение бесплодия методом экстракорпорального оплодотворения, были разделены на группу пациенток с «бедным» овариальным ответом (случай) и группу пациенток с нормальным овариальным ответом (контроль). Значимыми факторами риска развития «бедного» овариального ответа явились старший возраст пациенток и более ранний возраст наступления менопаузы у их матерей. Также на развитие «бедного» овариального ответа в программах экстракорпорального оплодотворения влияли: большее число прерываний беременности и стимуляций овуляции в анамнезе, более редкий и менее длительный прием гормональных контрацептивов. Протокол стимуляции овуляции не влиял на число полученных фолликулов и ооцитов у пациенток группы «бедного» овариального ответа и группы контроля. Беременность чаще наступала у пациенток, стимуляция овуляции которых проводилась с помощью короткого протокола с антагонистами гонадотропин-рилизинг-гормона.
Ключевые слова: «бедный» овариальный ответ, снижение овариального резерва, вспомогательные репродуктивные технологии, экстракорпоральное оплодотворение, протокол с агонистами гонадотропин-рилизинг-гормона, протокол с антагонистами гонадотропин-рилизинг-гормона.
Key words: poor ovarian response, low ovarian reserve, assisted reproductive technologies (ART), in vitro fertilization (IVF), protocol of GnRHa, protocol of GnRH-ant.
Ключевые слова: «бедный» овариальный ответ, снижение овариального резерва, вспомогательные репродуктивные технологии, экстракорпоральное оплодотворение, протокол с агонистами гонадотропин-рилизинг-гормона, протокол с антагонистами гонадотропин-рилизинг-гормона.
________________________________________________
Key words: poor ovarian response, low ovarian reserve, assisted reproductive technologies (ART), in vitro fertilization (IVF), protocol of GnRHa, protocol of GnRH-ant.
Полный текст
Список литературы
1. Ulug U, Ben-Shlomo I, Turan E. Conception rates following assisted reproduction in poor responder patients: a retrospective study in 300 consecutive cycles. Reprod Biomed Online 2003; 6: 439–43.
2. Badawy A, Wageah A, M. El Gharib, Ezz Eldin Osman. Prediction and Diagnosis of Poor Ovarian Response: The Dilemma. J Reprod Infertil 2011; 12 (4): 241–8.
3. Ferraretti AP, La Marca A, Fauser BC et al. On behalf of the ESHRE working group ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26 (7): 1616–24.
4. Kamble L, Gudi A, Shah A, Homburg R. Poor responders to controlled ovarian hyperstimulation for in vitro fertilization (IVF). Hum Fertil (Camb) 2011; 14 (4): 230–45.
5. Baird DT, Benagiano G, Cohen J et al. Physiopathological determinants of human infertility. Hum Reprod Update 2002; 8 (5): 435–47.
6. Boudjenah R, Molina-Gomes D, Torre A, Bergere M et al. Genetic polymorphisms influence the ovarian response to rFSH stimulation in patients undergoing in vitro fertilization programs with ICSI. PLoS One 2012; 7 (6): e38700.
7. Feyles V, Gianetto-Berruti A. Poor responders in assisted reproduction cycles. Minerva Ginecol 2005; 57: 1–14.
8. Vollenhoven B, Osianlis T, Catt J. Is there an ideal stimulation regimen for IVF for poor responders and does it change with age? JARG 2008; 25: 523–9.
9. Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine. Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry. Fertil Steril 2007; 87 (6): 1253–66.
10. Приказ Министерства здравоохранения РФ от 30.08.2012 №107н «О порядке использования вспомогательных репродуктивных технологий, противопоказаниях и ограничениях к их применению».
11. Johnson NP, Bagrie EM, Coomarasamy A et al. Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy. BJOG 2006; 113 (12): 1472–80.
12. Cook CL, Siow Y, Taylor S et al. Serum Mullerian inhibiting substance levels during normal menstrual cycles. Fertil Steril 2002; 73 (4): 859–61.
13. Fauser BC, Diedrich K, Devroey P. Evian Annual Reproduction (EVAR) Workshop Group 2007. Predictors of ovarian response: Progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 2008; 14: 1–14.
14. Padhy N, Gupta S, Mahla A et al. Demographic characteristics and clinical profile of poor responders in IVF/ICSI: a comparative study. J Hum Reprod Sci 2010; 3 (2): 91–4.
15. Klonoff-Cohen H. Female and male lifestyle habits and IVF: What is known and unknown. Human Reproduction Update Advance Access published on February 11, 2005. Hum Reprod Update 2005; 11: 179–203.
16. Hendriks DJ, te Velde ER, Looman CW et al. Expected poor ovarian response in predicting cumulative pregnancy rates: A powerful tool. Reprod Biomed Online 2008; 17: 727–36.
17. Klinkert ER, Broekmans FJ, Looman CW et al. Expected poor responders on the basis of an antral follicle count do not benefit from a higher starting dose of gonadotrophins in IVF treatment: A randomized controlled trial. Hum Reprod 2005; 20: 611–5.
18. Жахур Н.А. Дифференцированная тактика лечения больных с преждевременной недостаточностью яичников. АГ-инфо. 2012; 1: 38–42.
19. Layman LC. Editorial: BMP15–the first true ovarian determinant gene on the X-chromosome? J Clin Endocrinol Metab 2006; 91: 1673–6.
20. La Marca A, Malmusi S, Guilini S et al. Anti-Mullerian hormone plasma levels in spontaneous menstrual cycle and during treatment with FSH to induce ovulation. Hum Reprod 2004; 19 (12): 2738–41.
21. Siobán D. Harlow, Pangaja Paramsothy. Menstruation and the Menopausal Transition. Obstet Gynecol Clin North Am 2011; 38 (3): 595–607.
22. Deb S, Campbell BK, Pincott-Allen C et al. Quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti-Müllerian hormone and small antral follicle count using three-dimensional ultrasound. Ultrasound Obstet Gynecol 2012; 39 (5): 574–80.
23. Marci R, Caserta D, Dolo V et al. GnRH antagonist in IVF poor-responder patients: Results of a randomized trial. Reprod Biomed Online 2005; 11: 189–93.
24. Sunkara SK, Coomarasamy A, Faris R et al. Long gonadotropinreleasing hormone agonist versus short agonist versus antagonist regimens in poorresponders undergoing in vitro fertilization: a randomized controlled trial. Fertil Steril 2014; 101 (1): 147–53.
25. Franco JG Jr, Baruffi RL, Mauri AL et al. GnRH agonist versus GnRH antagonist in poor ovarian responders: a meta-analysis. Reprod Biomed Online 2006; 13 (5): 618–27.
2. Badawy A, Wageah A, M. El Gharib, Ezz Eldin Osman. Prediction and Diagnosis of Poor Ovarian Response: The Dilemma. J Reprod Infertil 2011; 12 (4): 241–8.
3. Ferraretti AP, La Marca A, Fauser BC et al. On behalf of the ESHRE working group ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26 (7): 1616–24.
4. Kamble L, Gudi A, Shah A, Homburg R. Poor responders to controlled ovarian hyperstimulation for in vitro fertilization (IVF). Hum Fertil (Camb) 2011; 14 (4): 230–45.
5. Baird DT, Benagiano G, Cohen J et al. Physiopathological determinants of human infertility. Hum Reprod Update 2002; 8 (5): 435–47.
6. Boudjenah R, Molina-Gomes D, Torre A, Bergere M et al. Genetic polymorphisms influence the ovarian response to rFSH stimulation in patients undergoing in vitro fertilization programs with ICSI. PLoS One 2012; 7 (6): e38700.
7. Feyles V, Gianetto-Berruti A. Poor responders in assisted reproduction cycles. Minerva Ginecol 2005; 57: 1–14.
8. Vollenhoven B, Osianlis T, Catt J. Is there an ideal stimulation regimen for IVF for poor responders and does it change with age? JARG 2008; 25: 523–9.
9. Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine. Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry. Fertil Steril 2007; 87 (6): 1253–66.
10. Приказ Министерства здравоохранения РФ от 30.08.2012 №107н «О порядке использования вспомогательных репродуктивных технологий, противопоказаниях и ограничениях к их применению».
11. Johnson NP, Bagrie EM, Coomarasamy A et al. Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy. BJOG 2006; 113 (12): 1472–80.
12. Cook CL, Siow Y, Taylor S et al. Serum Mullerian inhibiting substance levels during normal menstrual cycles. Fertil Steril 2002; 73 (4): 859–61.
13. Fauser BC, Diedrich K, Devroey P. Evian Annual Reproduction (EVAR) Workshop Group 2007. Predictors of ovarian response: Progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 2008; 14: 1–14.
14. Padhy N, Gupta S, Mahla A et al. Demographic characteristics and clinical profile of poor responders in IVF/ICSI: a comparative study. J Hum Reprod Sci 2010; 3 (2): 91–4.
15. Klonoff-Cohen H. Female and male lifestyle habits and IVF: What is known and unknown. Human Reproduction Update Advance Access published on February 11, 2005. Hum Reprod Update 2005; 11: 179–203.
16. Hendriks DJ, te Velde ER, Looman CW et al. Expected poor ovarian response in predicting cumulative pregnancy rates: A powerful tool. Reprod Biomed Online 2008; 17: 727–36.
17. Klinkert ER, Broekmans FJ, Looman CW et al. Expected poor responders on the basis of an antral follicle count do not benefit from a higher starting dose of gonadotrophins in IVF treatment: A randomized controlled trial. Hum Reprod 2005; 20: 611–5.
18. Жахур Н.А. Дифференцированная тактика лечения больных с преждевременной недостаточностью яичников. АГ-инфо. 2012; 1: 38–42.
19. Layman LC. Editorial: BMP15–the first true ovarian determinant gene on the X-chromosome? J Clin Endocrinol Metab 2006; 91: 1673–6.
20. La Marca A, Malmusi S, Guilini S et al. Anti-Mullerian hormone plasma levels in spontaneous menstrual cycle and during treatment with FSH to induce ovulation. Hum Reprod 2004; 19 (12): 2738–41.
21. Siobán D. Harlow, Pangaja Paramsothy. Menstruation and the Menopausal Transition. Obstet Gynecol Clin North Am 2011; 38 (3): 595–607.
22. Deb S, Campbell BK, Pincott-Allen C et al. Quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti-Müllerian hormone and small antral follicle count using three-dimensional ultrasound. Ultrasound Obstet Gynecol 2012; 39 (5): 574–80.
23. Marci R, Caserta D, Dolo V et al. GnRH antagonist in IVF poor-responder patients: Results of a randomized trial. Reprod Biomed Online 2005; 11: 189–93.
24. Sunkara SK, Coomarasamy A, Faris R et al. Long gonadotropinreleasing hormone agonist versus short agonist versus antagonist regimens in poorresponders undergoing in vitro fertilization: a randomized controlled trial. Fertil Steril 2014; 101 (1): 147–53.
25. Franco JG Jr, Baruffi RL, Mauri AL et al. GnRH agonist versus GnRH antagonist in poor ovarian responders: a meta-analysis. Reprod Biomed Online 2006; 13 (5): 618–27.
2. Badawy A, Wageah A, M. El Gharib, Ezz Eldin Osman. Prediction and Diagnosis of Poor Ovarian Response: The Dilemma. J Reprod Infertil 2011; 12 (4): 241–8.
3. Ferraretti AP, La Marca A, Fauser BC et al. On behalf of the ESHRE working group ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26 (7): 1616–24.
4. Kamble L, Gudi A, Shah A, Homburg R. Poor responders to controlled ovarian hyperstimulation for in vitro fertilization (IVF). Hum Fertil (Camb) 2011; 14 (4): 230–45.
5. Baird DT, Benagiano G, Cohen J et al. Physiopathological determinants of human infertility. Hum Reprod Update 2002; 8 (5): 435–47.
6. Boudjenah R, Molina-Gomes D, Torre A, Bergere M et al. Genetic polymorphisms influence the ovarian response to rFSH stimulation in patients undergoing in vitro fertilization programs with ICSI. PLoS One 2012; 7 (6): e38700.
7. Feyles V, Gianetto-Berruti A. Poor responders in assisted reproduction cycles. Minerva Ginecol 2005; 57: 1–14.
8. Vollenhoven B, Osianlis T, Catt J. Is there an ideal stimulation regimen for IVF for poor responders and does it change with age? JARG 2008; 25: 523–9.
9. Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine. Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry. Fertil Steril 2007; 87 (6): 1253–66.
10. Приказ Министерства здравоохранения РФ от 30.08.2012 №107н «О порядке использования вспомогательных репродуктивных технологий, противопоказаниях и ограничениях к их применению».
11. Johnson NP, Bagrie EM, Coomarasamy A et al. Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy. BJOG 2006; 113 (12): 1472–80.
12. Cook CL, Siow Y, Taylor S et al. Serum Mullerian inhibiting substance levels during normal menstrual cycles. Fertil Steril 2002; 73 (4): 859–61.
13. Fauser BC, Diedrich K, Devroey P. Evian Annual Reproduction (EVAR) Workshop Group 2007. Predictors of ovarian response: Progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 2008; 14: 1–14.
14. Padhy N, Gupta S, Mahla A et al. Demographic characteristics and clinical profile of poor responders in IVF/ICSI: a comparative study. J Hum Reprod Sci 2010; 3 (2): 91–4.
15. Klonoff-Cohen H. Female and male lifestyle habits and IVF: What is known and unknown. Human Reproduction Update Advance Access published on February 11, 2005. Hum Reprod Update 2005; 11: 179–203.
16. Hendriks DJ, te Velde ER, Looman CW et al. Expected poor ovarian response in predicting cumulative pregnancy rates: A powerful tool. Reprod Biomed Online 2008; 17: 727–36.
17. Klinkert ER, Broekmans FJ, Looman CW et al. Expected poor responders on the basis of an antral follicle count do not benefit from a higher starting dose of gonadotrophins in IVF treatment: A randomized controlled trial. Hum Reprod 2005; 20: 611–5.
18. Жахур Н.А. Дифференцированная тактика лечения больных с преждевременной недостаточностью яичников. АГ-инфо. 2012; 1: 38–42.
19. Layman LC. Editorial: BMP15–the first true ovarian determinant gene on the X-chromosome? J Clin Endocrinol Metab 2006; 91: 1673–6.
20. La Marca A, Malmusi S, Guilini S et al. Anti-Mullerian hormone plasma levels in spontaneous menstrual cycle and during treatment with FSH to induce ovulation. Hum Reprod 2004; 19 (12): 2738–41.
21. Siobán D. Harlow, Pangaja Paramsothy. Menstruation and the Menopausal Transition. Obstet Gynecol Clin North Am 2011; 38 (3): 595–607.
22. Deb S, Campbell BK, Pincott-Allen C et al. Quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti-Müllerian hormone and small antral follicle count using three-dimensional ultrasound. Ultrasound Obstet Gynecol 2012; 39 (5): 574–80.
23. Marci R, Caserta D, Dolo V et al. GnRH antagonist in IVF poor-responder patients: Results of a randomized trial. Reprod Biomed Online 2005; 11: 189–93.
24. Sunkara SK, Coomarasamy A, Faris R et al. Long gonadotropinreleasing hormone agonist versus short agonist versus antagonist regimens in poorresponders undergoing in vitro fertilization: a randomized controlled trial. Fertil Steril 2014; 101 (1): 147–53.
25. Franco JG Jr, Baruffi RL, Mauri AL et al. GnRH agonist versus GnRH antagonist in poor ovarian responders: a meta-analysis. Reprod Biomed Online 2006; 13 (5): 618–27.
________________________________________________
2. Badawy A, Wageah A, M. El Gharib, Ezz Eldin Osman. Prediction and Diagnosis of Poor Ovarian Response: The Dilemma. J Reprod Infertil 2011; 12 (4): 241–8.
3. Ferraretti AP, La Marca A, Fauser BC et al. On behalf of the ESHRE working group ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26 (7): 1616–24.
4. Kamble L, Gudi A, Shah A, Homburg R. Poor responders to controlled ovarian hyperstimulation for in vitro fertilization (IVF). Hum Fertil (Camb) 2011; 14 (4): 230–45.
5. Baird DT, Benagiano G, Cohen J et al. Physiopathological determinants of human infertility. Hum Reprod Update 2002; 8 (5): 435–47.
6. Boudjenah R, Molina-Gomes D, Torre A, Bergere M et al. Genetic polymorphisms influence the ovarian response to rFSH stimulation in patients undergoing in vitro fertilization programs with ICSI. PLoS One 2012; 7 (6): e38700.
7. Feyles V, Gianetto-Berruti A. Poor responders in assisted reproduction cycles. Minerva Ginecol 2005; 57: 1–14.
8. Vollenhoven B, Osianlis T, Catt J. Is there an ideal stimulation regimen for IVF for poor responders and does it change with age? JARG 2008; 25: 523–9.
9. Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine. Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry. Fertil Steril 2007; 87 (6): 1253–66.
10. Приказ Министерства здравоохранения РФ от 30.08.2012 №107н «О порядке использования вспомогательных репродуктивных технологий, противопоказаниях и ограничениях к их применению».
11. Johnson NP, Bagrie EM, Coomarasamy A et al. Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy. BJOG 2006; 113 (12): 1472–80.
12. Cook CL, Siow Y, Taylor S et al. Serum Mullerian inhibiting substance levels during normal menstrual cycles. Fertil Steril 2002; 73 (4): 859–61.
13. Fauser BC, Diedrich K, Devroey P. Evian Annual Reproduction (EVAR) Workshop Group 2007. Predictors of ovarian response: Progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 2008; 14: 1–14.
14. Padhy N, Gupta S, Mahla A et al. Demographic characteristics and clinical profile of poor responders in IVF/ICSI: a comparative study. J Hum Reprod Sci 2010; 3 (2): 91–4.
15. Klonoff-Cohen H. Female and male lifestyle habits and IVF: What is known and unknown. Human Reproduction Update Advance Access published on February 11, 2005. Hum Reprod Update 2005; 11: 179–203.
16. Hendriks DJ, te Velde ER, Looman CW et al. Expected poor ovarian response in predicting cumulative pregnancy rates: A powerful tool. Reprod Biomed Online 2008; 17: 727–36.
17. Klinkert ER, Broekmans FJ, Looman CW et al. Expected poor responders on the basis of an antral follicle count do not benefit from a higher starting dose of gonadotrophins in IVF treatment: A randomized controlled trial. Hum Reprod 2005; 20: 611–5.
18. Жахур Н.А. Дифференцированная тактика лечения больных с преждевременной недостаточностью яичников. АГ-инфо. 2012; 1: 38–42.
19. Layman LC. Editorial: BMP15–the first true ovarian determinant gene on the X-chromosome? J Clin Endocrinol Metab 2006; 91: 1673–6.
20. La Marca A, Malmusi S, Guilini S et al. Anti-Mullerian hormone plasma levels in spontaneous menstrual cycle and during treatment with FSH to induce ovulation. Hum Reprod 2004; 19 (12): 2738–41.
21. Siobán D. Harlow, Pangaja Paramsothy. Menstruation and the Menopausal Transition. Obstet Gynecol Clin North Am 2011; 38 (3): 595–607.
22. Deb S, Campbell BK, Pincott-Allen C et al. Quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti-Müllerian hormone and small antral follicle count using three-dimensional ultrasound. Ultrasound Obstet Gynecol 2012; 39 (5): 574–80.
23. Marci R, Caserta D, Dolo V et al. GnRH antagonist in IVF poor-responder patients: Results of a randomized trial. Reprod Biomed Online 2005; 11: 189–93.
24. Sunkara SK, Coomarasamy A, Faris R et al. Long gonadotropinreleasing hormone agonist versus short agonist versus antagonist regimens in poorresponders undergoing in vitro fertilization: a randomized controlled trial. Fertil Steril 2014; 101 (1): 147–53.
25. Franco JG Jr, Baruffi RL, Mauri AL et al. GnRH agonist versus GnRH antagonist in poor ovarian responders: a meta-analysis. Reprod Biomed Online 2006; 13 (5): 618–27.
Авторы
Р.Э.Ванян, Н.В.Долгушина
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России, Москва
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России, Москва
________________________________________________
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.