微刺激方案与常规促排卵方案在高龄卵巢低反应不育女性中的前后周期比较  

Comparison of minimal ovarian stimulation protocol and conventional stimulation protocol for infertile women in advanced age and poor ovarian response

作　　者：曹蓓[1,2] 李艳萍[1] 刘冬娥[1] 刘能辉[1] 张琼[1] 郝洁[1] 朱琳[1] 

机构地区：[1]中南大学湘雅医院妇产科生殖医学中心,长沙410008 [2]湖南省株洲市妇幼保健院生殖科,株洲412000

出　　处：《生殖医学杂志》2014年第9期709-713,共5页Journal of Reproductive Medicine

摘　　要：目的探讨36岁以上高龄、卵巢低反应（POR）不育患者最适宜的体外受精-胚胎移植（IVF-ET）促排卵方案。方法回顾性分析34例36～45岁POR患者接受IVF-ET助孕治疗的临床结局,根据患者前后促排卵方案的不同分为常规促排卵方案34个周期和灵活微刺激方案34个周期。比较前后两种不同方案患者的临床资料及助孕结局。结果 （1）微刺激周期、常规促排卵周期人绒毛膜促性腺激素（HCG）日的雌二醇（E2）水平、获卵数、MⅡ数、优胚率比较无显著性差异（P〉0.05）;（2）微刺激周期的基础卵泡刺激素（FSH）水平高于常规促排卵周期,窦卵泡数则少于常规促排卵周期,差异均有统计学意义（P〈0.05）;（3）常规促排卵周期的促性腺激素（Gn）天数、Gn总量大于微刺激周期,差异有统计学意义（P〈0.05）;（4）微刺激周期的受精数、可利用胚胎数、优胚数、冻存胚胎数、MⅡ率及正常受精率均高于常规促排卵周期,差异有统计学意义（P〈0.05）。结论对于高龄POR妇女,微刺激方案与常规促排卵方案相比,可以获得较多的受精数、可利用胚胎数、优胚数和冻存胚胎数,MⅡ率和正常受精率也有提高,且微刺激方式更加温和,既减轻了患者的痛苦,又减少了Gn的用量和医疗费用,提示对于高龄POR不育症患者可能更宜用微刺激促排卵方案。Objective：To explore the more appropriate ovarian stimulation protocol for women in advanced age.Methods：The clinical outcomes of 34 patients aged 36 to 45years old and received IVF-ET were reviewed.The patients were sequentially treated with conventional stimulation protocol（34cycles）and minimal ovarian stimulation protocol（34cycles）.Then clinical data and results of the two protocols were compared.Results：There were no obvious differences in E2 levels on the HCG day,number of oocytes retrieved,number of MⅡ oocytes and good quality embryo rate between minimal ovarian stimulation cycles and convention stimulation cycles.The basic FSH levels of minimal ovarian stimulation cycles were significantly higher than those of minimal ovarian stimulation cycle,but number of antral follicle（AFC）was significantly less（P〈0.05）.The duration and the total dosage of gonadotropin（Gn）used in convention stimulation cycles were significantly higher than those in minimal ovarian stimulation cycles（P〈0.05）.In terms of numbers of fertilized oocytes,available embryo,good quality embryos,frozen-thawed embryos,MⅡ oocyte rate and normal fertilization rate in minimal ovarian stimulation cycles were significantly higher than those in convention stimulation cycles（P〈0.05）.Conclusions：Minimal ovarian stimulation protocol can obtain more numbers of fertilized oocytes,available embryos,good quality embryos,frozen-thawed embryos,and higher M Ⅱ rate and normal fertilization rate in the patients with poor ovarian response.At the same time,it can relieve the patient＇s pain and reduce the dosage of Gn used and medical expenses.Therefore,the minimal stimulation protocol is more appropriate for the infertile patients in advanced age with poor ovarian response.

关 键 词：高龄 卵巢低反应 微刺激方案 常规促排卵方案 卵泡波 

分 类 号：Q492.5[生物学—生理学]