卵巢功能正常患者使用不同促性腺激素联合安宫黄体酮促排卵的IVF/ICSI-FET结局  

Endocrine characteristics and the clinical outcomes of using three gonadatropins and medroxy-progestrone acetate during ovarian stimulation in normal ovulatory women undergoing IVF/ICSI-FET treatments

作　　者：朱秀娴[1,2] 陈秋菊[1] 匡延平[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院辅助生殖科,上海200011 [2]上海交通大学医学院九院临床医学院,上海200011

出　　处：《生殖与避孕》2015年第5期310-317,共8页Reproduction and Contraception

摘　　要：目的：比较2种人绝经期促性腺激素（hMG）和尿源性卵泡刺激素（u—FSH）联合安宫黄体酮（MPA）对卵巢功能正常患者促排卵的内分泌特征及体外受精／卵胞质内单精子注射（IVF／ICSI）临床结局。方法：回顾性分析258个行IVF／ICSI取卵周期的患者资料，入组患者均采用促性腺激素（Gn）联合MPA方案进行促排卵，根据所使用的Gn药物的类型分为：A组，hMG-A组（商品名：丰原，n=105）；B组，hMG．B组（商品名：乐宝得，n=90）；C组，U-FSH（商品名：丽中宝，n=63）。比较3组患者促排卵过程中的卵巢反应、胚胎实验室结局及行冻融胚胎移植（FET）后的妊娠结局。结果：A、B、C组的获卵数分别为12．1±6．9、12．1±5．7、13．1±8．9，3组间比较无统计学差异（P〉O．05）；3组的成熟卵数、正常受精卵数、卵裂数、可用胚胎数等胚胎实验室指标均无统计学差异（P〉0．05）；促排卵过程中患者的LH水平维持在0．04~7．38IU／L之间，未监测到LH峰：FET后，A、B、C组的临床妊娠率（43．48％VS37．93％vs 40．74％）和种植率（34．88％VS22．22％VS26．42％）组间比较均无统计学差异（P〉0．05）。结论：促排卵过程中加用MPA能够有效抑制旱发性LH峰，卵泡期高孕激素状态促排卵（PPOs）为基于FET的促排卵提供了新思路，在PPOS方案中对于卵巢功能正常的患者使用hMG和u-FSH进行促排卵具有相同的临床效果。Objective： To explore the clinical characteristics of gonadotropins （Gn） and medroxyprogestrone acetate （MPA） in normal ovulatory women undergoing IVF/ICSI treatments using the three types of Gn. Methods： A total of 258 IVF/ICSI patients undergoing ovarian stimulation in a Gn and MPA protocol were analyzed in this retrospective study and were allocated into three groups according to the Gn used： group A, hMG-A （brand name： fengyuan, n=105）; group B, hMG-B （brand name： lebaode, n=90）; group C, u-FSH （brand name： lishenbao, n=63）. The hormone profiles such as serum FSH, LH, E2, P, [3-hCG levels, embryological characteristics, and the pregnant results after frozen-thawed embryo transfer （FET） were compared among the three groups. Results： There was no significant difference in the number of oocytes retrieved among the three groups （12.1 ±6.9 vs 12.1 ± 5.7 vs 13.1 ± 8.9, P〉0.05）. Other indicators such as the number of mature oocyte, fertilization, cleavage and viable embryo were similar （P〉0.05）. No premature LH surges were detected, with a range of 0.04-7.38 IU/L. No differences were found in the clinical pregnancy rate per transfer cycle （43.48% vs 37.93% vs 40.74%, P〉0.05） and the implantation rate （34.88% vs 22.22% vs 26.42%, P〉0.05）. Conclusion： MPA is an effective oral alternative for the prevention of premature LH surges. Progestin-primed ovarian stimulation （PPOS） is a novel regimen of ovarian stimulation in combination with embryo cryopreservation, in which the two types ofhMG are as effective as uFSH.

关 键 词：人绝经期促性腺激素(hMG) 尿源性卵泡刺激素(u-FSH) 黄体生成素峰(LH峰) 安宫黄体酮(MPA) 冻融胚胎移植(FET) 

分 类 号：R714.8[医药卫生—妇产科学]