控制性超排卵治疗中卵巢反应不良与反应不均一患者的临床特征  

Clinical feature of patients with poor ovarian response and inhomogeneity response in controlled ovarian hyperstimulation

作　　者：徐慧灵[1] 李洁[1] 于文娟[1] 万塞红[1] 

机构地区：[1]中山大学附属第一医院生殖中心,广州510080

出　　处：《中华临床医师杂志（电子版）》2008年第12期32-35,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：广东省自然科学基金(2003-31691)

摘　　要：目的探讨在体外受精-胚胎移植(IVF-ET)周期控制性超排卵(COH)治疗中出现卵巢反应不良患者的临床特征。方法回顾性分析2005至2006年中山大学附属第一医院生殖中心采用GnRH-a/Gn/HCG方案进行COH出现卵巢反应不良(以获卵数≤5个为诊断标准),并在1年内进行了两个或两个以上周期的患者资料,共70例,154个周期。根据患者获卵数将其分为两组,A组22例患者48个周期均为获卵数≤5个;B组48例患者共106个周期,其中获卵数≤5个和获卵数>5个各53个周期。结果68.6%(48/70)患者经过调整GnRH-a或Gn剂量在另一周期中获卵数>5个。A组患者年龄、基础FSH、FSH/LH值、Gn启动量和总量、HCG日FSH、LH水平均显著高于B组(P<0.01),而HCG日血清E2水平、≥12mm卵泡数均显著低于B组(P<0.01)。B组患者反应正常周期HCG日血清E2水平、≥12mm卵泡数均显著高于反应不良周期(P<0.01)。获卵数与HCG日E2、≥12mm卵泡数成正相关(P<0.01)。结论在控制性超排卵方案治疗中大部分卵巢反应不良患者存在卵巢反应的不均一性,通过调整COH方案可以获得正常的卵巢反应。患者年龄、基础FSH、基础FSH/LH值可预测重复卵巢反应不良的发生,在该类患者中增加Gn剂量并不能显著增加卵泡数和获卵数。Objective To identify the character of patients suffering from poor ovarian response in controlled ovarian hyperstimulation（COH） during the in vitro fertilization and embryo transfer cycle（ IVF- ET）. Methods A retrospective study was undertaken on a cohort of patients who ever had poor response in COH using GnRH-a/Gn/HCG protocol, and had underwent at least two cycles in one year in our hospital during 2005 -2006 （70 patients, 154 cycles ）. Poor ovarian response was defined as ≤ 5 oocytes at ovum pick up（OPU）. The patients were divided into two groups. Patients in group A （22 patients ,48 cycles） had poor response cycle only, but in group B （48 patients, 106 cycles, in which 53 cycles were poor response） each of them had at least one normal response cycle. Results 68.6% （48/70） patients who ever had poor response in COH could reverse ovarian response to Gn after changing the protocol, which without diminish of reserved ovarin. The values of women＇s age, basal FSH levels, FSH/LH, initiative and total gonadotropin （Gn） dose in group A were significantly higher than those in group B （ P 〈 0. 01 ） ,and the E2 level on HCG administration day and the number of retrieved oocytes were significantly lower in group A （ P 〈 0.01 ）. In group B, the E2 level on HCG administration day were higher positive correlation with the oocyte number （ P 〈 0.01 ）. There was no significant correlation between the number of retrieved oocytes and the initiative or total Gn dose in either group A or B. Conclusion Our data demonstrate that partial poor responders have inhomogencity on ovarian response in COH, which depend on the medicine administration. Women＇s age,basal FSH levels and FSH/LH are useful predictors for the recurrent poor ovarian response. And more Gn administration may not help in these group patients.

关 键 词：卵巢功能试验 超排卵 受精 体外 胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]