卵巢功能减退患者采用自然周期或微刺激方案治疗策略及结局  

Pregnancy outcome of poor ovarian responder with natural cycle or minimal stimulation protocol

作　　者：高彦[1] 冒韵东[1] 王媁[1] 黄洁[1] 钱晓乔[1] 刁飞扬[1] 刘嘉茵[1] 

机构地区：[1]南京医科大学第一附属医院生殖医学科,南京210029

出　　处：《生殖医学杂志》2016年第10期897-900,共4页Journal of Reproductive Medicine

基　　金：江苏省妇幼保健重点人才FRC201307

摘　　要：目的探讨卵巢功能减退患者,采用自然周期或微刺激周期体外受精（IVF）/卵胞浆内单精子注射（ICSI）治疗的临床参数（获卵率、受精率、妊娠率）,为临床治疗提供依据。方法从本生殖中心CCRM数据库中选取6 632例卵巢功能减退患者的临床资料,其中自然周期2 253例,微刺激周期4 379例,在月经第3天B超监测窦卵泡数目、直径,检查基础FSH、LH、E2值。窦卵泡直径〈8mm,FSH〈16U/L、E2〈280pmol/L的患者,采用克罗米芬/加HMG微刺激促排卵,否则行自然周期。当优势卵泡直径〉15mm,平均每个优势卵泡E2约等于1 100pmol/L时,于当天20：30肌肉注射0.1mg GnRH激动剂（GnRH-a）诱发排卵,34-36h后取卵。在内膜达8-14mm时行新鲜胚胎移植,否则行胚胎的玻璃化冷冻,待以后行自然周期移植。结果自然周期或微刺激IVF/ICSI治疗时,卵巢功能减退患者的每移植周期妊娠率为30%左右,随着治疗次数的增加,妊娠率没有明显改变,连续4周期累计妊娠率约46%。结论卵巢功能减退患者在自然周期/微刺激治疗中,妊娠率没有随着治疗次数的增加而下降,建议连续采用自然周期/微刺激治疗,节约治疗时间、提高累积妊娠率。年龄〉45岁的不孕症患者应适时终止自然周期/微刺激治疗,或改用供卵IVF治疗。Objective：To analyze the clinical parameters including number of oocyte retrieved,fertilization rate,and pregnancy rate among the poor ovarian responder with natural cycle or minimal stimulation protocol in IVF-ET/ICSI.Methods：The data of 6 632 poor ovarian responders were extracted from CCRM database of the reproductive center.Among the patients,there were 2 253 patients with nature cycles and 4 379 patients with minimal stimulation protocol.The number and diameter of antral follicles,and the basal levels of FSH,LH and E2 were monitored on day 3of menstrual cycle.The patients with antral follicle diameter8mm,FSH〈16 U/L and E〈2280pmol/L took clomiphene citrate and/or HMG minimal stimulation protocol;otherwise,the patients took natural cycle.When the follicular diameter was15mm and E2 levels per dominant follicle were about 1 100pmol/L,the patients received 0.1 mg GnRH agonist injection at20：30to induce ovulation.The oocytes were picked-up 34-36 hours after trigger.The fresh embryo transfer was performed when endometrial thickness reached 8-14 mm;otherwise,the vitrificated embryos were transferred in the next cycle.Results：The pregnancy rate per transfer cycle was about 30%in poor ovarian responder with natural cycle or minimal stimulation protocol.The pregnancy rate is not significantly changed along with increased number of cycles.The cumulative pregnancy rate was about 46% after 4cycles.Conclusions：The pregnancy rate is not decreased along with increased number of cycles in the natural cycle or minimal stimulation protocol cycle.It is recommend to continuous use of natural cycle or micro-stimulation treatment for poor ovarian responder,which can save treatment time and improve cumulative pregnancy rate.

关 键 词：卵巢功能减退 自然周期 克罗米芬 微刺激 

分 类 号：R[医药卫生]