两种微刺激方案在卵巢低反应患者中的应用  

Clinical analysis for application of two mini-stimulation protocols on patients with poor ovarian response

作　　者：李真[1] 耿爱华[1] 秦伟[1] 孙丽君[1] 管一春[1] 王兴玲[1] 

机构地区：[1]郑州大学第三附属医院生殖医学中心,郑州450052

出　　处：《生殖与避孕》2015年第10期687-692,共6页Reproduction and Contraception

摘　　要：目的：探讨卵巢低反应（poor ovarian response,POR）患者在体外受精/卵胞质内单精子显微注射-胚胎移植（IVF/ICSI-ET）技术中应用微刺激方案更合适的取卵时机。方法：回顾性分析接受微刺激方案IVF/ICSI-ET助孕的POR患者共363个周期的临床资料,分为来曲唑（LE）＋尿促性腺素（hMG）＋后半程氯米芬片（CC）组（A组）和全程CC＋hMG组（B组）。观察分析临床及实验室指标、不同取卵时机获卵情况及后续冻融胚胎移植（FET）周期的妊娠结局。结果：患者的Gn使用天数、扳机日E2、取卵前日E2、MⅡ卵率组间比较差异均有统计学意义（P〈0.05）。取卵前日E2与扳机日E2相比上升者注射达菲林后33 h取卵获卵情况要差于35 h和36 h取卵者（P〈0.05）,而取卵前日E2与扳机日E2相比下降者,下降比例≤1/3者获卵率要明显优于〉1/3者（P〈0.05）。结论：POR患者应用微刺激方案时,取卵前日E2与扳机日E2相比,上升者,可注射达菲林后35~36 h取卵;下降者,下降比例≤1/3,可33 h取卵,如下降比例〉1/3,则提示33 h后取卵获卵情况差。Objective： To explore a more appropriate ovarian stimulation protocol for the poor ovarian response（POR） patients in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer（IVF/ICSIET）. Methods： A retrospective study was performed in 363 POR patients undergoing the treatment of ministimulation protocols IVF/ICSI-ET. The patients were divided into letrozole（LE）＋h MG＋clomifene（CC） later taken group（group A） and CC in the whole process＋h MG group（group B）. The clinical and laboratory data, oocytes retrieval situation in different time and pregnancy outcome of subsequent frozen-thawed embryo transfer（FET）cycle were compared between the two groups. Results： Of the Gn used days, serum E2 on the trigger day, serum E2 on the day before oocyte retrieval day and MⅡ oocyte rate, there were significant differences（P〈0.05） between the two groups. For patients whose serum E2 level ascended from the trigger day to the day before oocyte retrieval day, the status of retriving transvaginal oocyte 33 h after triptorelin administered was worse than 35 h and 36 h（P〈0.05）. For patients whose serum E2 level descended, the retrieved oocyte rate in the group of descending proportion equal or less than one third was better than that in the group of descending proportion more than one third. Conclusion： In POR patients treated with mini-stimulation protocol, comparing the serum E2 level on the day before oocyte retrieval day with the trigger day, when it ascends, transvaginal oocyte retrived can be performed35-36 h after triptorelin administered; when it descends and the proportion is less than one third, transvaginal oocyte retrived can be performed 33 h after triptorelin administered; if the proportion is more than one third, it prompts that the situation is worse.

关 键 词：微刺激方案 来曲唑(LE) 氯米芬(CC) 卵巢低反应(POR) 取卵时机 

分 类 号：R714.8[医药卫生—妇产科学]