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Abstract：
The number of mature oocytes is a key factor in the success of Assisted Reproductive Techniques (ART). Exogenous gonadotropins are administered during ovarian stimulation in order to maximize the number of oocytes available for fertilization. During stimulation, monitoring is mandatory to evaluate individual response, to avoid treatment complications and assist in the determination of the optimal day for final oocyte maturation and oocyte retrieval. Routine monitoring during stimulation includes transvaginal ultrasound examinations and measurement of serum estradiol (E2). Due to multifollicular growth of follicles of varying size, serum E2 levels are commonly supraphysiological and often variable, rendering E2-measurement during ovarian stimulation unreliable as a determinant of oocyte maturity. In contrast to serum E2, serum Inhibin A levels increase once a minimum follicle size of 12-15 mm is achieved. Due to this fact, serum Inhibin A levels could present in combination with ultrasound monitoring a more reliable parameter to determine the optimal follicle size for final oocyte maturation, as only follicles with a size of 12 mm and beyond will contribute to the serum Inhibin A level. This prospective observational, cross-sectional study demonstrates, that on the day of final oocyte maturation serum Inhibin A is strongly correlated to the number of follicles ≥15 mm (0.72) and to the number of retrieved and mature oocytes (ρ 0.82/0.77, respectively), whereas serum E2 is moderately correlated to the parameters mentioned above (ρ 0.64/0.69/0.69, respectively). With an area under the curve (AUC) of 0.91 for Inhibin A, compared to an AUC of 0.84 for E2, Inhibin A can be regarded as a better predictor for the optimal timing of trigger medication with a threshold number of ≥10 mature oocytes. It can be concluded from this data that serum Inhibin A in combination with transvaginal ultrasound monitoring may be a more powerful tool in the decision making process on trigger timing as compared to E2.
摘要：
成熟卵母细胞的数量是辅助生殖技术（ART）成功的关键因素。在卵巢刺激期间施用外源性促性腺激素以使可用于受精的卵母细胞的数量最大化。在刺激期间,监测是评估个人反应的强制性要求，以避免治疗并发症，并协助确定最终卵母细胞成熟和取卵的最佳日期。刺激期间的常规监测包括经阴道超声检查和血清雌二醇（E2）的测量。由于不同大小的卵泡的多卵泡生长，血清E2水平通常是超生理的，通常是可变的，在卵巢刺激期间进行E2测量不可靠，作为卵母细胞成熟度的决定因素。与血清E2相反，一旦达到12-15毫米的最小卵泡大小，血清抑制素A水平就会增加。由于这一事实,血清抑制素A水平与超声监测相结合，可以提供更可靠的参数，以确定最终卵母细胞成熟的最佳卵泡大小，因为只有大小为12毫米及以上的卵泡会导致血清抑制素A水平。这种前瞻性的观察，横断面研究表明，在最终卵母细胞成熟当天，血清抑制素A与卵泡数≥15mm（0.72）以及回收和成熟卵母细胞数（分别为ρ0.82/0.77）密切相关，而血清E2与上述参数中度相关（分别为ρ0.64/0.69/0.69）。抑制素A的曲线下面积（AUC）为0.91，与E2的AUC为0.84相比,在阈值数量≥10个成熟卵母细胞的情况下,抑制素A可被认为是触发药物治疗最佳时机的更好预测指标.从该数据可以得出结论，与E2相比，血清抑制素A与经阴道超声监测相结合可能是触发时机决策过程中更强大的工具。
