高反应患者重复长方案对卵巢反应性及妊娠结局的影响  

Ovarian response and pregnancy outcome in hyper-responders during repeated in vitro fertilization and embryo transfer

作　　者：倪郝[1] 何思锐 李红[1] 陈东红[1] 华芮[1] 陈思梅[1] 全松[1] 

机构地区：[1]南方医科大学南方医院妇产科生殖医学中心,广东广州510515 [2]南方医科大学2010级临床医学1班,广东广州510515

出　　处：《南方医科大学学报》2015年第6期912-915,共4页Journal of Southern Medical University

基　　金：国家自然科学基金(81170575)~~

摘　　要：目的探讨高反应患者在体外受精-胚胎移植（IVF-ET）中行重复周期垂体降调节长方案,调整治疗策略对卵巢反应性及妊娠结局的影响。方法选择南方医院生殖医学中心2008年1月~2011年12月30例高反应患者60个长方案行IVF-ET治疗不孕症的周期进行回顾性分析,比较高反应患者前后周期治疗的临床特点。结果与第一治疗周期相比,患者行重复周期治疗时年龄明显增加（P〈0.001）,Gn启动剂量明显减少（P=0.049）,h CG日雌激素（E2）水平降低（P=0.027）,获卵数减少（P=0.030）,优质胚胎形成率（P〈0.001）、临床妊娠率（P=0.009）升高,但在降调节剂量、Gn应用总量、Gn刺激时间、2原核（PN）个数、受精数、卵巢过度刺激综合征（OHSS）高危倾向周期取消率无显著性差异（P〉0.05）,再次发生卵巢高反应者占40%（12/30）。结论对于高反应患者,行长方案重复IVF周期治疗时应注意减小Gn启动剂量,减少再次发生高反应的风险,改善助孕结局。Objective To evaluate the ovarian response and pregnancy outcomes in patients with excessive ovarian response receiving long- protocol pituitary down- regulation during repeated in vitro fertilization and embryo transfer（IVF- ET）.Methods Sixty IVF- ET cycles from January 2008 to December 2011 were analyzed retrospectively. The clinical characteristics were compared between the various treatment cycles. Results Compared with those with the first treatment cycle, the patients receiving repeated cycles had a significantly older age（P〈0.001）, reduced initial doses of Gn（P=0.049）, and moderately lowered estrogen level on the day of h CG administration（E2）（P=0.027） and the number of oocytes retrieved（P=0.030）. The high- quality embryo formation rate（P〈0.001） and clinical pregnancy rate（P=0.009） were both significantly higher in patients with repeated cycles. The dose for down-regulation, total Gn dose, duration of Gn stimulation, number of two pronuclei（PN）,number of fertilized oocyte, and the cancellation rate for a high risk of ovarian hyperstimulation syndrome（OHSS） were all comparable between the two groups（P〉0.05）. The recurrence rate of ovarian excessive respond was 40%（12/30）. Conclusion For patients receiving repeated IVF treatment cycle with a high ovarian response, a smaller initial dose of Gn should be used to minimize the risk of hyper-response and improve the outcome of assisted reproductive treatment.

关 键 词：体外受精-胚胎移植 卵巢高反应 长方案 重复周期 

分 类 号：R714.8[医药卫生—妇产科学]