背景:孤立性低促性腺激素性腺功能减退症(IHH)是一种由促性腺激素释放激素轴功能障碍引起的罕见生殖障碍。患有IHH的患者通常不能进入青春期或通过青春期发育并且在没有外源性激素补充的情况下保持不育。本研究旨在调查接受辅助生殖技术(ART)治疗的IHH患者的人群特征和生殖结局。并评估IHH患者卵巢反应和临床妊娠的最佳预测因子。
方法:这项回顾性队列研究包括83名接受新ART周期的IHH患者和未诊断的对照组(n=676)。生成受试者工作特征曲线以评估卵巢反应的预测因子。采用Logistic回归分析探讨影响IHH患者临床妊娠的独立因素。
结果:与对照组相比,IHH组的基础激素水平明显降低。IHH组的受精率和2PN率显著高于IHH组,可转移胚胎的数量也是如此。该研究确定AMH是IHH卵巢高反应的最佳预测因子,AUC为0.767(0.573,0.961)。相反,卵泡-卵母细胞指数(FOI)在预测低卵巢反应性方面表现出最高的AUC,为0.814(0.642,0.985).基于FOI值,IHH患者分为两组,研究发现临床妊娠率显着提高(43.8%,58%;P<0.001)和活产率(37.5%,58%;P<0.001)从低FOI组到正常FOI组。此外,回收的卵母细胞数量,受精胚胎/率,2PN胚胎/率,正常FOI组的优质胚胎数量明显高于低FOI组(P<0.001或P=0.005)。Logistic回归分析显示FOI是影响IHH患者临床妊娠的独立因素。
结论:研究结果表明,IHH患者对IVF治疗反应良好。尽管AMH是卵巢高反应的最佳预测因子,FOI在预测卵巢低反应方面具有最好的能力。FOI是影响IHH行IVF/ICSI患者临床妊娠的独立因素。
BACKGROUND: Isolated Hypogonadotropic Hypogonadism (IHH) is a rare reproductive disorder caused by the dysfunction of the gonadotropin-releasing hormone axis. Patients with IHH typically fail to enter or develop through puberty and retain infertile without an exogenous hormone supplement. This study aimed to investigate the population characteristics and reproductive outcomes in IHH patients undergoing assisted reproductive technology (ART) treatment, and evaluate the best-performed predictor for ovarian response and clinical pregnancy in patients with IHH.
METHODS: This retrospective cohort study included 83 women with IHH who underwent fresh ART cycles and non-diagnosed controls (n = 676). The receiver operating characteristic curves were generated to assess the predictor for the ovarian response. Logistic regression analyses were performed to investigate the independent factors for clinical pregnancy in IHH.
RESULTS: The basal hormone levels were significantly lower in the IHH group compared to the control group. The fertilization rate and 2PN rate were significantly higher in IHH groups, as was the number of transferable embryos. The study identified that AMH was the best predictor of high ovarian response in IHH, with an AUC of 0.767 (0.573, 0.961). Conversely, the follicle-to-oocyte index (FOI) exhibited the highest AUC of 0.814 (0.642, 0.985) for predicting low ovarian response. Based on FOI values, the IHH patients were divided into two groups, and the study found a significant increase in clinical pregnancy rate (43.8%, 58%; P < 0.001) and live birth rate (37.5%, 58%; P < 0.001) from the low FOI to the normal FOI groups. Moreover, the number of oocytes retrieved, fertilized embryos/rate, 2PN embryos/rate, and number of excellent quality embryos were significantly higher in the normal FOI group (P < 0.001 or P = 0.005) than in the low FOI group. Logistic regression analyses revealed FOI to be the independent factor affecting clinical pregnancy in IHH patients.
CONCLUSIONS: The study findings suggest that patients with IHH were good responders to IVF treatment. Although AMH was the best-performed predictor for the high ovarian response, FOI had the best capability in predicting the low ovarian response. FOI was an independent factor affecting clinical pregnancy in IHH undergoing IVF/ICSI.