改良长方案与超长方案在卵巢储备功能下降患者中的应用  

Comparison between ultra-long-term down-regulation protocol and modified long-tem protocol in poor ovarian reserve patients

作　　者：黎淑贞[1] 陈希曦[1] 李冬梅[1] 崔媛媛[1] 陈晓燕[1] 

机构地区：[1]广东省江门市中心医院生殖中心,529030

出　　处：《中国综合临床》2013年第8期879-881,共3页Clinical Medicine of China

摘　　要：目的分析卵巢储备功能下降患者使用改良长方案与超长方案进行体外受精-胚胎移植（IVF—ET）的临床结局，旨在寻找更合适的促排卵方案。方法回顾性分析2011年10月至2012年7月在我院接受体外受精（XVF）或卵细胞浆单精子注射（mSI）助孕的78例卵巢储备功能下降患者的临床资料。改良长方案43例（A组），黄体中期使用长效曲普瑞林0．375mg降调，超促排卵启动日加用丙氨瑞林0．15mg／d至肌肉注射人绒毛膜促性腺激素（HCG）日。超长方案35例（B组），黄体中期使用长效曲普瑞林1．5mg降调28d后再次使用曲普瑞林1．2—1．3mg降调节，16d后使用促性腺激素（Gn）超促排卵。比较两组Gn剂量、获卵数、可用胚胎数、胚胎种植率、临床妊娠率、流产率。结果A、B组患者年龄、基础卵泡数、基础促卵泡生成素（FSH）、Gn剂量、获卵数、可用胚胎数、移植胚胎数比较差异均无统计学意义（P均〉0．05），临床妊娠率（32．56％与34．29％）、种植率（18．75％与20．97％）、流产率（0与8．33％）比较差异亦均无统计学意义（P均〉0．05）。结论改良长方案临床妊娠率、流产率与超长方案比较效果相当，但其较超长方案治疗时间短，又避免了可能过度抑制垂体功能的风险。Objective To compare the outcomes in pregnancy between the patients with poor ovarian reservation receiving ultra-long-term down-regulation protocol and modified long-term protocol who were undergoing in vitro fertilization （IVF） and intracytoplasmic sperm injection （ ICSI）, aiming at screening an optimal ovulation induction scheme. Methods Retrospectively analyzed the clinical data of 78 patients with poor ovarian reservation who underwent IVF or ICSI from October 2010 to July 2012. Forty-three patients received modified long-term protocol treatment （group A）, with 0. 375 mg long-acting triptorelin during the mid- luteal phase as well as superovulation start date plus alarelin （0. 15 mg/d） to intramuscular injection of human chorionic gonadotropin（HCG） day. Thirty-five patients received uhra-long-term down-regulation protocol （group B）. Triptorelin was injected intramuscularly in mid-luteal phase twice followed by triptorelin at a dose of 1.2 - 1.3 mg after 28 days of long-acting triptorelin treatment （ 1.5 mg）. Gonadotropin was started 16 days after the second GnRHa injection. The dose of Gn, number of oocytes retrieved, number of embryos available, implantation rate, pregnancy rate, and miscarriage rate were recorded and compared between the two groups. Results There was no significant difference between the two groups in the mean age of participants, basal follicular number, FSH,the dose of Gn used, number of oocytes retrieved, number of embryos available, number of implanted embryos, Pregnancy rate （32. 56% vs. 34. 29% ）, implantation rate （ 18.75 % vs. 20. 97% ） and miscarriage rate （0 vs. 8.33% ） （ P 〉 0. 05 ）. Conclusion No significant difference was found between the two groups in clinical pregnancy rate and abortion rate. But modified long-term protocol needs a shorter treatment period than the ultra-long-term protocol. Moreover, it reduces the risk of excessive suppression of pituitary function. Therefore, it takes advantages over the other in the clinical

关 键 词：卵巢储备功能下降 曲普瑞林 体外受精-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]