Study question Aim of this study was to investigate whether baseline androgen levels had a predictive value on stimulation outcomes in IVF cycles. Summary answer Baseline Δ4-Androstenedione (Δ4-A) and particularly the derived G-index, which also reflects the ovarian reserve capability, may serve as additional predictors of ovarian response to stimulation. What is known already Despite the several clinical, serological and ultrasound markers proposed so far, none have proved exempt from a high rate of false positives and negatives. The identification of reliable predictors of ovarian response continues to pose a challenge for reproductive physicians. Study design, size, duration Prospective study. Multiple linear regression and multivariate logistic regression were used to evaluate the predictive value of markers of response to controlled ovarian stimulation (COS). To compare the specificity of different biomarkers, receiver operating characteristic (ROC) curves were constructed to identify the global accuracy of our parameters of interest. Participants/materials, setting, methods The study included 91 infertile patients aged 30-45 years,awaiting the first IVF cycle at the Reproductive Medicine Unit of the San Paolo University Hospital in Milano.All women underwent the same long-protocol stimulation and the same starting dose of recombinant follicle-stimulating hormone (rFSH) was administered. As stimulation outcomes, the number of follicles recruited, Estradiol and Progesterone levels on the day of trigger, the total dose of gonadotropins administered and the number of oocytes collected were recorded. Main results and the role of chance Pearson’s correlation revealed a statistically significant inverse correlation between oocytes collected and age (r= -0.333,p<0.001) and a positive correlation with AMH (r = 0.360,p<0.001), antral follicle count (AFC) (r = 0.639, p < 0.001) and Androstenedione (Δ4-A) (r = 0.359,p<0.001). No significant correlation was reported with FSH (r=-0.133,p=0.207) and total Testosterone (r = 0.180,p=0.088). The G-Index (=AMH ng/ml*AFC/Δ4-A ng/dl) revealed a significant higher level in COS good responders (p < 0.001) compared to AMH, AFC and Δ4-A alone. Limitations, reasons for caution Although the same stimulation regimen and starting dose of gonadotropin were used, subsequent individualization of treatment certainly influenced the results. This was considered as an insurmountable bias. Furthermore, the conclusions of this study, due to the population size, need to be validated in studies with larger populations. Wider implications of the findings Baseline serum Δ4-A, presumably crucial for ensuring a regular early follicular growth, is a reliable marker of ovarian response to stimulation.Since the ovarian capacity to respond to gonadotropins does not depend exclusively on the presence of follicles,we suggest a new index able to contemplate both ovarian reserve and Δ4-A level. Trial registration number N/A

中文翻译：

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P-644 Δ4-雄烯二酮基线血清水平反映了卵巢对刺激的反应：建立一个新的指数来预测 IVF 周期的结果

研究问题 本研究的目的是调查基线雄激素水平是否对 IVF 周期的刺激结果具有预测价值。总结答案 基线 Δ4-雄烯二酮 (Δ4-A)，特别是衍生的 G 指数，也反映了卵巢储备能力，可作为卵巢对刺激反应的额外预测因子。已知情况 尽管迄今为止提出了几种临床、血清学和超声标记物，但没有一个被证明可以免于高假阳性和假阴性率。确定卵巢反应的可靠预测因子继续对生殖医生构成挑战。研究设计、规模、持续时间 前瞻性研究。多元线性回归和多变量逻辑回归用于评估控制卵巢刺激（COS）反应标志物的预测价值。为了比较不同生物标志物的特异性，构建了受试者工作特征 (ROC) 曲线来确定我们感兴趣的参数的全局准确性。参与者/材料、设置、方法 该研究包括 91 名年龄在 30-45 岁的不孕症患者，在米兰圣保罗大学医院生殖医学科等待第一个 IVF 周期。所有女性都接受了相同的长方案刺激和相同的刺激。给予重组促卵泡激素（rFSH）的起始剂量。作为刺激结果，在触发当天招募的卵泡数量、雌二醇和孕酮水平，记录所施用的促性腺激素的总剂量和收集的卵母细胞数量。主要结果和机会 Pearson 相关性的作用揭示了收集的卵母细胞与年龄（r = -0.333，p<0.001）之间存在统计学上显着的负相关，并且与 AMH（r = 0.360，p<0.001）、窦卵泡计数呈正相关（r = 0.360，p<0.001）。 AFC) (r = 0.639, p < 0.001) 和雄烯二酮 (Δ4-A) (r = 0.359, p < 0.001)。与 FSH (r=-0.133, p=0.207) 和总睾酮 (r = 0.180, p=0.088) 没有显着相关性。与单独的 AMH、AFC 和 Δ4-A 相比，G 指数 (=AMH ng/ml*AFC/Δ4-A ng/dl) 显示 COS 良好反应者的水平显着更高 (p < 0.001)。限制，谨慎的原因 尽管使用了相同的刺激方案和促性腺激素的起始剂量，随后的个体化治疗肯定会影响结果。这被认为是一种不可克服的偏见。此外，由于人口规模，本研究的结论需要在更大人群的研究中得到验证。研究结果的更广泛意义 基线血清 Δ4-A，可能对确保正常的早期卵泡生长至关重要，是卵巢对刺激反应的可靠标志。由于卵巢对促性腺激素的反应能力并不完全取决于卵泡的存在，我们提出了一个能够同时考虑卵巢储备和 Δ4-A 水平的新指标。试用注册号 N/A 需要在更大人群的研究中进行验证。研究结果的更广泛意义 基线血清 Δ4-A，可能对确保正常的早期卵泡生长至关重要，是卵巢对刺激反应的可靠标志。由于卵巢对促性腺激素的反应能力并不完全取决于卵泡的存在，我们提出了一个能够同时考虑卵巢储备和 Δ4-A 水平的新指标。试用注册号 N/A 需要在更大人群的研究中进行验证。研究结果的更广泛意义 基线血清 Δ4-A，可能对确保正常的早期卵泡生长至关重要，是卵巢对刺激反应的可靠标志。由于卵巢对促性腺激素的反应能力并不完全取决于卵泡的存在，我们提出了一个能够同时考虑卵巢储备和 Δ4-A 水平的新指标。试用注册号 N/A