3种不同超促排卵方案对冻融胚胎移植结局的影响  

Comparison of Frozen-thawed Embryo Transfer Pregnancy Outcome among 3 Protocols of Controlled Ovarian Hyperstimulation

作　　者：邵娟[1] 董曦[2] 徐军[2] 傅薇[2] 李路[2] 彭献东[2] 陈华[2] 余敏[2] 刘素英[2] 孙晓溪[2,3] 

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院,上海200030 [2]复旦大学附属妇产科医院,上海集爱遗传与不育诊疗中心,上海200011 [3]上海市女性生殖内分泌相关疾病重点实验室,上海200011

出　　处：《生殖与避孕》2012年第4期241-247,共7页Reproduction and Contraception

摘　　要：目的:探讨不同超促排卵方案全部胚胎冷冻后行冻融胚胎移植(FET)的临床妊娠结局。方法:回顾性分析360例患者全胚胎冷冻后复苏移植周期的临床结局。按促排卵方案分为3组,A组:GnRH-a长方案组(n=131),B组:GnRH-a短方案(n=110),C组:CC+hMG组(n=119),按年龄段(<35岁,≥35岁)分别比较3组的促排卵效果及妊娠结局,并且以基础FSH(bFSH)=10 IU/L为界,把C组患者分为bFSH<10 IU/L和bFSH≥10 IU/L 2个亚组,比较其促排卵效果及妊娠结局。结果:C组获卵数、Gn使用总量、Gn用药天数显著低于A和B组(P<0.05),受精率和优质胚胎率高于A和B组(P<0.05);不同年龄段中C组与A和B组的临床妊娠结局均无统计学差异。3组的临床妊娠率分别为42.5%、35.6%、38.9%,胚胎种植率分别为23.9%、21.9%、17.2%,组间无统计学差异(P>0.05)。C组中bFSH≥10 IU/L亚组与bFSH<10 IU/L亚组的促排卵效果及妊娠结局无显著差异(P>0.05)。结论:CC+hMG方案在全部胚胎冷冻后行FET的患者中能取得与GnRH-α长、短方案相似的临床效果,同时Gn的用量大大低于长、短方案组,降低了药物对卵巢过度刺激造成的并发症,减轻了患者的经济和心理负担。Objective： To investigate the frozen-thawed embryo transfer（FET） outcomes of clomiphene minimal stimulation in patients with all embryos cryopreservation.Methods： A total of 360 patients with whole embryo cryopreservation were retrospectively analyzed and then FET was performed.All patients were divided into 3 groups,group A： GnRHa long protocol（131 cases）,group B： GnRHa short protocol（110 cases）,group C： colmiphene minimal stimulation protocol（119 cases）.The efficacy of induced ovulation and pregnancy outcome were compared among the 3 groups according to the age（ 35 years,≥ 35 years）.In group C,the patients were divided into two sub-groups according to the basic FSH value（bFSH = 10 IU/L） and their ovulation and pregnancy outcome were compared.Results： In group C,the number of retrieved oocytes,dose of Gn,Gn duration were significantly lower than those of groups A and B（P〈0.05） and the fertilization rate and good quality embryo rate were higher than those in groups A and B（P〈0.05）.Group C and group A,B showed no significant difference in clinical outcome of pregnancy in different age.The total clinical pregnancy rate and implantation rate of groups A,B,C were respectively 42.5%,35.6%,38.9% and 23.9%,21.9%,17.2%.In group C,bFSH 10 IU/L sub group and bFSH 10 IU/L sub group showed no significant difference in ovulation efficacy and pregnancy outcome.Conclusion： The minimal stimulation protocol can acquire similar clinical effect in the all embryo cryopreservation and then FET patients with GnRH-a long/short protocol,at the same time,the dosage of Gn is significantly lower and complications caused by ovarian hyperstimulation is reduced,lightening the patients’economic and mental burden.

关 键 词：克罗米芬(CC) 玻璃化冷冻 冻融胚胎移植(FET) 

分 类 号：R714.8[医药卫生—妇产科学]