不同促排卵方案在IVF卵巢低反应患者中的应用及对血清和卵泡液中GDF-9、BMP-15水平的影响  

The application of three different ovulation protocols in poor responders and their impact on the levels of GDF-9 and BMP-15 in serum and follicular fluid

作　　者：孙丽君[1] 许小燕[1] 钱秋然[1] 王雪梅[1] 李真[1] 李俊敏[1] 

机构地区：[1]郑州大学第三附属医院,郑州450052

出　　处：《中国优生与遗传杂志》2014年第10期125-128,62,共5页Chinese Journal of Birth Health & Heredity

基　　金：河南省卫生厅科技攻关项目(200903074)

摘　　要：目的探讨GnRH-a短方案、GnRH-ant方案及来曲唑微刺激三种不同促排卵方案在IVF卵巢低反应患者促排卵中的应用效果及其对血清和卵泡液中GDF-9、BMP-15水平的影响。方法选择在我院生殖医学中心接受IVF/ICSI且卵巢低反应的不孕症患者共89例,随机地分为三组:A组(GnRH-a短方案组)33例,B组(GnRH-ant方案组)31例,C组(来曲唑微刺激方案组)25例。采用酶联免疫吸附试验(ELISA)检测所有患者HCG日血清及取卵日卵泡液内GDF-9、BMP-15水平,用化学发光法测定所有患者基础内分泌值和HCG日内分泌值,分析不同促排卵方案患者的Gn用量,Gn用药天数,获卵数,受精率,卵裂率,优质胚胎率,着床率,周期取消率,移植周期临床妊娠率,流产率等相关指标。结果 (1)Gn用药天数、获卵数、受精率、卵裂率、优质胚胎率、周期取消率、移植周期临床妊娠率、流产率、着床率在A、B、C三组之间无统计学差异(P>0.05);Gn总量在A、B两组明显高于C组(P<0.05);(2)A、B、C三组血清和卵泡液中的GDF-9水平无统计学差异(P>0.05);C组血清和卵泡液中的BMP-15水平均显著高于A、B两组(P<0.05);A、B、C三组血清的GDF-9和BMP-15水平均显著低于卵泡液中的水平(P<0.05)。结论 IVF卵巢低反应患者应用GnRH-ant方案可以获得与GnRH-a短方案相似的临床效果;来曲唑联合小剂量Gn微刺激方案Gn用量较少,获得了与GnRH-a短方案及GnRH-ant方案相似的临床妊娠率,可能与来曲唑增加血清和卵泡液中BMP-15水平,提高了卵巢的反应性有关。Objective ： To probe the application of three different ovulation protocols which are used in poor ovarian responders in IVF cycles and their impact on the levels of GDF-9 and BMP-15 in serum and follicular fluid. Methods ： All the eighty-nine objects who underwent IVF/ICSI and predicted a low response to controlled ovarian hyperstimulation were randomly assigned into three groups .. group A （GnRH-a short protocol group）, 33 cases ： group B （GnRH antagonist group）, 31 cases group C （ministimulation group）, 25 cases.Detected the levels of GDF-9 and BMP-15 in serum on HCG administration day and follicular fluid on oocyte retrieval day of all patients by ELISA and detected endocrine levels on D2-5 of menstrual cycle and HCG administration day of all patients by chemiluminescence.Analyzed the difference of Gn dose, Gn days and other dates of clinical and embryo laboratory.Results ： （ 1 ） There is no significant difference in Gn days, the numbers of oocyte, the fertilization rate, the cleavage rate, the rate of high quality embryos, cycle cancellation rate, the clinical pregnancy rate, the abortion rate and the implantation rate among the three groups of group A, B and C （P 〉0.05）, the total doses of Gn in group A and B are significantly higher than that in group C （P 〈0.05） . （2） There is no significant difference in the concentrations of GDF-9 in serum and follicular fluid among the three groups of group A, B and C （P 〉0.05） ~ the concentrations of BMP-15 in serum and follicular fluid in group C are significantly higher than that in Group A and B ; the concentrations of GDF-9 and BMP-15 in serum among the three groups are significantly lower than that in follicular fluid （P 〈 0.05） .Conclusions ： GnRH antagonist protocol can achieve the same clinical result in poor ovarian responders in IVF than GnRH-a short protocol. The minimal stimulation protocol with Letrozole can achieve the same approving clinical pregnancy rate than GnRH-a short protocol and GnRH antagoni

关 键 词：体外受精-胚胎移植 卵巢反应不良 微刺激 来曲唑 GDF-9 BMP-15 

分 类 号：R711.6[医药卫生—妇产科学]