微刺激和自然周期体外受精/卵胞浆内单精子注射治疗的临床结局分析  

Clinical outcomes analysis of mild-stimulation or natural cycle treatment in IVF/ICSI

作　　者：高彦[1] 冒韵东[1] 王嫜[1] 黄洁[1] 钱晓乔[1] 刘嘉茵[1] 

机构地区：[1]南京医科大学第一附属医院生殖医学科,南京市210029

出　　处：《生殖医学杂志》2013年第1期34-38,共5页Journal of Reproductive Medicine

基　　金：江苏省卫生厅项目(H200905);973子课题(2007CB948103)

摘　　要：目的探讨高龄、卵巢功能减退、有诱导排卵禁忌证、既往在本院或外院接受常规超促排卵体外受精/卵胞浆内单精子注射胚胎移植(IVF/ICSI-ET)中表现为卵巢低反应、优质胚胎率低下和(或)反复移植失败的患者,采用微刺激周期和自然周期IVF/ICSI-ET治疗中的临床参数,包括平均获卵数、妊娠率、流产率、临床妊娠率等指标。方法 1.将月经第3天窦卵泡直径<8 mm,卵泡刺激素(FSH)<20 IU/L,雌二醇(E_2)<280 pmol/L.的患者,从第3天开始服克罗米芬50 mg至取卵日,第8天B超监测,酌情增加人绝经期促性腺激素(HMG)注射;2.窦卵泡直径>8 mm、FSH<20 IU/L、E_2>280 pmol/L,或既往周期卵母细胞形态异常,有诱导排卵禁忌证患者采用自然周期。两组均在主导卵泡直径>15 mm,平均每个卵泡E_2≈1.100pmol/L时,肌注0.2 mg曲普瑞林诱发排卵,34～36 h采卵。在内膜达8～14 mm时行胚胎移植。否则实行胚胎的玻璃化冷冻,待以后进行自然周期冻胚移植。结果从2008年开始共1,223起始周期,取卵1,103周期,卵母细胞早排120周期,完成IVF/ICSI-ET治疗958周期,其中克罗米芬微刺激周期669个,自然周期289个,每年的卵母细胞早排、术获卵的风险以及胚停率下降,妊娠率上升,总的周期取消率无显著改变。并随着周期的增加,每周期的妊娠率无下降趋势,多胎率明显降低。结论对于高龄、卵巢功能减退、有诱导排卵禁忌证、或既往常规超促排卵IVF/ICSI表现为卵巢低反应,优质胚胎率低下和(或)反复移植失败的低生育力患者,使用微刺激周期或自然周期方案是比较好的选择。Objective. Poor ovarian responders with aged,ovarian dysfunction,ovulation induction contraindications, and poor ovarian responders previously received a conventional stimulation protocol for IVF/ICSI and presented low high-quality embryo rate,repeated implantation failure from our hospital or other hospital were treated with mild stimulation or natural cycle protocols. Clinical parameters were investigated, including average number of oocytes retrieved, pregnancy rate, miscarriage rate, pregnancy rate per cycle, etc. Methods： 1. The patients with follicle diameter ~8 mm,follicle stimulating hormone （FSH）%20 IU/ L,estradiol （Ez）~280 pmol/L on day 3 were assigned to mild stimulation group, and used clomiphene citrate 50 mg from day 3 to oocyte retrieval day, underwent ultrasound monitoring on day 8 when appropriate HMG injection were conducted. 2. The patients with follicle diameter ~8 mm,FSH %20 IU/ L,E2 〉280 pmol/L on day 3, or with oocyte abnormality in previous cycle, or with ovulation induction contraindications were using natural cycle protocol. If the dominant follicle diameter 〉15 mm and average E2 per follicle about 1,100 pmol/L, triptorelin 0.2 mg were injected intramuscularly for trigger, and oocytes were picked up 34 to 36 hours later. Embryos were transferred when endometrium reached 8-14 mm, otherwise vitrified cryopreservation for later natural cycle embryo transfer. Results. A total of 1,223 started cycles were conducted since 2008,with 1,103 oocyte retrieval cycle and 120 cancelled cycles. Nine hundred and fifty eight cycles were completed IVF/ICSI-ET treatment,with 669 mild stimulation cycles and 289 natural cycles. The risks of early ovulation and none oocyte retrieved and the embryo loss rate decreased, and pregnancy rate increased year by year, while the total cancel rate was not changed. For the individual, the multiple pregnancy rate was significantly decreased but the pregnancy rate per cycle was stable along with the increase of cycle number. Conclusions. For patients with

关 键 词：自然周期 克罗米芬 微刺激 

分 类 号：R[医药卫生]