卵巢储备标志物已被证明在临床实践中表现非常好。虽然这被广泛认可,目前,在如何在临床实践中使用新的生物标志物方面还没有达成共识。这项研究是使用Delphi技术在意大利IVF中心进行的,一个经过验证的建立共识的过程。简而言之,为负责IVF中心的临床医生开发了三个连续的问卷。在第一轮中,参与者被要求对一系列关于卵巢反应的分类和生物标志物的诊断作用的陈述的重要性进行评分.在第3轮中,要求参与者对前两轮得出的陈述清单进行评估。有120名受访者。在许多方面达成共识:(a)根据以下条件预测卵巢反应不良:AMH<1ng/ml或AFC<7,FSH≥10IU/l,年龄≥40岁;(b)根据以下条件预测高反应:AMH>3ng/ml或AFC>14;(c)第3天的FSH测量应始终与雌二醇相关;(d)可以随机测量AMH;(e)使用2D技术测量AFC可能被认为是足够的,并且(f)AFC应在卵泡总数为9毫米的早期进行测量。本研究表明,临床医生已经就新的卵巢储备标志物提高IVF安全性和性能的重要性和使用达成了广泛共识。
Ovarian reserve markers have been documented to perform very well in the clinical practice. While this is widely recognized, still now there is no
consensus on how to use new biomarkers in the clinical practice. This study was conducted among Italian IVF centres using the Delphi technique, a validated
consensus-building process. Briefly three consecutive questionnaires were developed for clinicians in charge of IVF centres. In the first rounds, participants were asked to rate the importance of a list of statements regarding the categorization of ovarian response and the diagnostic role of biomarkers. In round 3, participants were asked to rate their agreement and
consensus on the list of statements derived from the first two rounds. There were 120 respondents.
Consensus was achieved for many points: (a) poor ovarian response is predicted on the basis of the following: AMH < 1 ng/ml or AFC < 7, FSH ≥ 10 IU/l, age ≥ 40 yrs; (b) hyper-response is predicted on the basis of the following: AMH > 3 ng/ml or AFC > 14; (c) day 3 FSH measurement should always be associated to estradiol; (d) AMH can be measured on a random basis; (e) the measurement of the AFC with the 2D technology may be considered adequate and (f) the AFC should be measured in the early follicular phase and consists in the total number of 2-9 mm follicles in both the ovaries. The present study suggests that extensive
consensus on the importance and use of new ovarian reserve markers to improve IVF safety and performance is already present among clinicians.