超短方案在卵巢低反应患者中的应用  

Clinical Outcomes of Ultrashort GnRH-agonist Flare Protocol in the Poor Ovarian Responders

作　　者：朱琴玲[1] 洪燕[1] 赵晓明[1] 徐冰[1] 姚宁[1] 孙赟[1] 

机构地区：[1]上海交通大学医学院附属仁济医院生殖医学科,上海200001

出　　处：《生殖与避孕》2012年第8期518-522,572,共6页Reproduction and Contraception

基　　金：上海市科委引导项目;项目号:114119a1900)

摘　　要：目的:探讨体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)周期中,超短方案在卵巢低反应患者(poor ovarian responders,PORs)中的应用。方法:回顾性分析342例PORs的401个IVF周期,根据促排卵方案不同分为超短方案组(A组,254例,291个周期)和微刺激方案组(B组,88例,110个周期)。比较A、B组的一般资料、妊娠结局以及周期取消率等指标,分析A、B组周期取消原因。结果:临床妊娠率/移植周期、种植率和流产率组间均无统计学差异(P>0.05),但A组累积妊娠率显著高于B组(25.1%vs 14.5%,P<0.05),周期取消率显著低于B组(17.5%vs 44.5%,P<0.05)。周期取消原因分析表明,微刺激组因内膜因素取消移植的比例显著高于超短方案组(22.4%vs 7.8%,P<0.05)。结论:在PORs中,超短方案周期取消率低,患者心理压力小,整个疗程耗时短。因此超短方案也是PORs可以选择的、较理想的促排卵方案。Objective： To assess the efficacy of ultrashort GnRH-agonist （GnRH-a） flare protocol in poor ovarian responders （PORs） undergoing in vitro fertilization. Mathods： A retrospective analysis was performed in a total of 342 patients, 401 IVF cycles. Among 254 patients, 291 IVF cycles were administered in ultrashort GnRH-a flare protocol （group A）; while 88 patients, 110 IVF cycles adopted mild ovarian stimulation protocol （group B）. Clinical outcomes and cycle cancellation rate were primary outcome measures. The number of retrieved oocytes and mature oocytes （metaphase II oocytes） were the secondary measures. The reasons of cycle cancellation were also analyzed. Results： The clinical pregnancy rate, the implantation rate and the miscarriage rate were not different between the two groups （P〉0.05）. Meanwhile, the cycle cancellation rate was significantly higher in group B （44.5%） than in group A （17. 5%）（P〈0.05）. With the analysis of the reasons of cycle cancellation, the rate of the endometrial factors in group B （22. 4%） was higher than that in group A （7.8%）（P〈0.05）, while other factors were similar in the two groups. Conclusion： In the PORs, the ultrashort GnRH-agonist flare protocol would decrease the cycle cancellation rate and relieve the treatment time and patients＇ psychological stress. So in the PORs, the ultrashort GnRH-agonist flare protocol may be a valid alternative treatment strategy.

关 键 词：IVF-ET 卵巢低反应(POR) 超短方案 微刺激方案 周期取消率 

分 类 号：R714.8[医药卫生—妇产科学]