卵巢储备功能减退患者自然周期取卵/排卵后继续黄体期促排卵的临床观察  

Feasibility analysis of luteal-phase ovarian stimulation after the natural cycle oocyte retrieval/ovulation in diminished ovarian reserve patients

作　　者：赵贝[1] 孙丽君[1] 胡继君[1] 冯营营[1] 李哲[1] 张俊韦 Zhao Bei;Sun Lijun;Hu Jijun;Feng Yingying;Li Zhe;Zhang Junwei(Reproductive Center of the Third Affiliated Hospital of Zhengzhou University,Zhenghou 450052,China)

机构地区：[1]郑州大学第三附属医院生殖医学中心,450052

出　　处：《中华生殖与避孕杂志》2018年第12期1005-1008,共4页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨卵巢储备功能减退(DOR)患者黄体期促排卵的可行性。方法应用回顾性队列研究分析本院接受体外受精/卵胞质内单精子显微注射(IVF/ICSI)助孕的DOR患者,共290个周期的临床资料,分别采用自然周期方案(164个周期)、自然周期取卵/排卵后继续黄体期促排卵方案(128个周期)行IVF/ICSI。比较患者临床、实验室及妊娠结局的各项指标。结果两组的年龄、不孕年限、体质量指数(BMI)、血清基础卵泡刺激素(FSH)及抗苗勒管激素(AMH)水平相比较,差异均无统计学意义(P>0.05);两组未获卵率及双原核(2PN)受精率差异均无统计学意义(P>0.05);黄体期促排卵组扳机日黄体生成素(LH)[(3.39±1.04) mIU/L]及提前排卵率[0.8%(1/128)]低于自然周期组[(14.45±4.23) mIU/L,16.0%(26/162)](P<0.001)。扳机雌二醇(E2)[(1 046.84±725.70) ng/L]、获卵数(2.6±2.1)、优质胚胎率[47.9%(90/188)]均高于自然周期组[(351.94±179.75) ng/L、0.8±0.7、31.5%(23/73)](P<0.001、P<0.001、P=0.017);黄体期促排卵组及自然周期组的临床妊娠率分别为26.8%、20.0%,早期流产率分别为13.3%、16.7%,累积妊娠率分别为28.3%、20.0%,组间比较差异均无统计学意义(P>0.05)。结论自然周期取卵/排卵后继续黄体期促排卵方案获卵数增多,优质胚胎率升高,提前排卵率降低,对于DOR患者而言,是一种可行的促排卵方案。ObjectiveTo investigate the feasibility of luteal-phase ovarian stimulation in diminished ovarian reserve (DOR) patients.MethodsA retrospective cohort study was used to analyze 290 cycles in infertile women with DOR, who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), of which 164 natural cycle protocol cycles and 128 luteal-phase ovarian stimulation protocol after the natural cycle oocyte retrieval or ovulation cycles. Then the clinical and laboratory indicators were compared between the two groups.ResultsThere was no significant difference in age, infertility, body mass index (BMI), serum basal follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels between the two groups (P>0.05). There was no significant difference in the rates of unobtained and two pronucleus (2PN) fertilization between the two groups (P>0.05). Luteinizing hormone (LH) [(3.39±1.04) mIU/L] and advance ovulation rate [0.8% (1/128)] were lower than those in the natural cycle group [(14.45±4.23) mIU/L, 16.0% (26/162)] (all P<0.001). The trigger estrogen (E2) [(1 046.84±725.70) ng/L], the number of retrieved eggs (2.6±2.1), and the rate of high-quality embryos [47.9% (90/188)] were all higher than those of the natural cycle group [(351.94±179.75) ng/L, 0.8±0.7, 31.5% (23/73)] (P<0.001, P<0.001, P=0.017). The clinical pregnancy rate (26.8% and 20.0%), the abortion rate (13.3% and 16.7%) and the cumulative pregnancy rate (28.3% and 20.0%) in the lutein phase prolongation group and the natural cycle group were not statistically different (P>0.05).ConclusionIn luteal-phase ovarian stimulation protocol, the number of acquired eggs increased, the rate of high-quality embryos increased, and the rate of premature ovulation decreased, so it is a feasible ovulation-promoting protocol for patients with DOR.

关 键 词：卵巢储备功能减退(DOR) 黄体期促排卵 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]