早卵泡期雌激素补充对高龄无明显窦状卵泡患者的应用价值  

Application of estrogen during early follicular phase to the elderly aged patients without apparent antral follicle

作　　者：邓玲 陈薪[1] 叶德盛[1] 张俊 陈士岭[1] Deng Ling;Chen Xin;Ye Desheng;Zhang Jun;Chen Shiling(Center for Reproductive Medicine,Department of Gynecology and Obstetrics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院妇产科生殖医学中心,广州510515

出　　处：《中华生殖与避孕杂志》2018年第11期927-930,共4页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金(81401177);广东省自然科学基金资助项目(2015A030313286);南方医院高层次匹配项目基金(G2014005)~~

摘　　要：目的探讨早卵泡期雌激素补充对高龄无明显窦状卵泡患者的应用价值。方法选取行体外受精/卵胞质内单精子显微注射(IVF/ICSI)治疗的24例高龄无明显窦状卵泡的不孕症患者,比较雌激素补充前、后卵巢储备功能指标的变化;根据所需雌激素补充时长分为A组(1～5 d)、B组(6～10 d)及C组(≥11 d),比较各组促排卵周期相关指标的差异。结果 (1)雌激素补充后患者出现卵泡,血清卵泡刺激素(FSH)水平[(16.53±9.74) IU/L]较基础FSH水平[(24.87±11.02) IU/L]显著降低(P=0.032),血清雌二醇(E2)水平[108.90(93.93,222.60) ng/L]较前[10.98(0.00,21.23) ng/L]显著升高,差异均具有统计学意义(P=0.001)。(2) A组、B组及C组患者雌激素补充后卵泡数均依次减少[2.0(1.5,3.0),1.0(1.0,2.8),1.0(1.0,1.0)](P=0.019),各组的获卵率分别为80.0%、70.8%及28.6%(P=0.039)。3组间的雌激素补充后FSH和E2水平、获卵数及正常受精率的差异无统计学意义(P>0.05)。(3)线性回归结果显示,雌激素补充时间与基础FSH水平呈正相关关系。结论早卵泡期雌激素补充可能有助于高龄无明显窦状卵泡患者较快募集卵泡,继而获得卵母细胞并形成可移植胚胎,从而改善IVF/ICSI结局。Objective To investigate the clinical value of estrogen supplementation during early follicular phase in the advanced aged patients with no apparent antral follicle.Methods Totally 24 elderly patients with no apparent antral follicle were included in the study, the ovarian reserve before and after estrogen supplementation was compared. They were categorized into group A (1-5 d), group B (6-10 d) and group C (≥11 d) according to the duration of estrogen administration that inducing follicle recruitment. Ovarian stimulation parameters and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes were compared among the three groups.Results 1) After estrogen supplementation, follicles appeared and the serum follicle stimulating hormone (FSH) levels [(16.53±9.74) IU/L] significantly declined compared with the baseline FSH levels [(24.87±11.02) IU/L](P=0.032), as well as serum estradiol (E2) levels [(108.90 (93.93,222.60) ng/L, 10.98 (0.0,21.23) ng/L, P=0.001)] significantly increased. 2) The number of follicle after estrogen supplementation reduced in series among group A, group B and group C [2.0(1.5,3.0), 1.0(1.0,2.8), 1.0(1.0,1.0)](P=0.019) and the oocyte yield rate was 80.0%, 70.8% and 28.6%, respectively (P=0.039). After estrogen supplementation, the serum FSH and E2 levels, the number of oocyte yield and normal fertilization rates were not statistically significant among the three groups. 3) The linear regression model identified that the duration of estrogen supplement was positively associated with baseline FSH levels.Conclusion Estrogen supplementation during early follicular phase might facilitate follicular recruitment to achieve oocytes and embryos as well as to improve IVF/ICSI outcomes in elderly aged patients with no apparent antral follicle.

关 键 词：雌激素 卵巢储备功能减退(DOR) 体外受精/卵胞质内单精子显微注射(IVF/ICSI) 

分 类 号：R714.8[医药卫生—妇产科学]