卵巢反应低下患者辅助生殖技术促排卵方案的对比分析  

Comparison and Analysis on the Poor Ovarian Response Infertile Patients Treated by Different Controlled Ovarian Stimulation Protocols in Assisted Reproductive Technology

作　　者：潘艳平[1] 夏飞[1] 茅彩萍[1] 何琦[1] 吴志南[1] 周安稳[1] 周卫琴[1] 

机构地区：[1]苏州大学附属第一医院,江苏苏州215006

出　　处：《实用妇产科杂志》2017年第5期352-357,共6页Journal of Practical Obstetrics and Gynecology

基　　金：江苏省妇幼健康科研项目(编号:F201547)

摘　　要：目的:通过比较卵巢反应低下(POR)患者在进行辅助生殖技术(ART)治疗中几种促排卵方案的治疗结局,探讨针对POR患者经济有效、个性化的促排卵方案。方法:回顾性分析行体外受精/卵细胞浆内单精子注射(IVF/ICSI)治疗的POR患者共302个周期,按不同促排卵方案分为4组:超短方案组(43个周期),短方案组(30个周期),氯米芬联合尿促性素微刺激方案组(CC+HMG组,62个周期),卵泡期尿促性素联合甲羟孕酮方案组(HMG+MPA组,167个周期)。对4组患者的促排卵情况、周期取消情况及每起始周期的临床结局进行比较。结果:(1)4组患者ART周期中Gn天数、Gn用量、药费、扳机日优势卵泡数、获卵率、性价比比较,差异有统计学意义(P<0.05);其中,超短方案组的Gn天数最长,Gn用量最多;短方案组扳机日优势卵泡数最多,完成1次治疗周期的药费最贵,相对取得1个可移植胚胎的性价比最差;CC+HMG组的Gn天数最短、Gn用量最少,但扳机日优势卵泡数最少,获卵率也最低;HMG+MPA组药费最低,获卵率最高,性价比最好。(2)在取消周期方面,4组间因异常受精及未受精、未卵裂、无可移植胚胎、无优质胚胎而取消周期的差异无统计学意义(P>0.05)。CC+HMG组及超短方案组的未获卵周期率高于短方案组及HMG+MPA组(P<0.05)。(3)4组方案每起始周期的临床妊娠率、着床率比较,差异无统计学意义(P>0.05)。HMG+MPA组的流产率低于CC+HMG组(P<0.05);HMG+MPA组每起始周期的继续妊娠率高于超短方案组与CC+HMG组(P<0.05)。结论:卵泡期HMG+MPA方案可能是POR患者的一种经济的、有效的、有利于患者的促排卵方案。Objective：To explore the effective,economical and personalized protocol for infertile patients with poor ovarian response（POR） ,via comparing treatment outcomes of different controlled ovarian stimulation proto- cols in assisted reproductive technology. Methods：Three hundred and two clinical cases of POR patients undergoing in vitro fertilization/intracytoplasmic sperm injection （IVF/ICSI） treatment were recruited in this study. According to the different ovarian stimulation protocols,these patients were divided into four groups：43 cycles treated with ultra-short protocol,30 cycles treated with short protocol,62 cycles treated with mini-stimulation protocol of clomiphene combined human menopausal gonadotropin and 167 cycles treated with progestin-pdmed ovarian stimulation of human menopausal gonadotropin combined medroxy-progesterone acetate in follicular phase. To compare retrospectively the controlled ovarian stimulation response, cycle cancellation and each starting period clinical outcome among the four groups. Results：（1）There were significant differences in the duration and the total doses of gonadotropin（Gn）,medicine fee, the advantage follicle numbers in trigger days, oocytes retrieved rate and Cost-effective（ P 〈0.05）among the four groups. Ultra-short protocol had the most duration and dose of Gn and were more expensive in medicine price generally. Short protocol had the most expensive in medicine fee to complete a treatment cycle,the advantage follicle numbers in trigger days, and the worst cost-effective to get a viable embryo. Mini-stimulation protocol had the least duration and dose of Gn,dominant follicle numbers in trigger days and oocytes retrieved rate. Human menopausal gonadotropin combined medroxy-progesterone acetate in follicular phase had the most oocytes retrieved rate and the best cost-effective. （2）In cycle cancelation, due to abnormal fertilization and un-fertilization, none cleavage and viable embryo to cancel cycles were no statistical difference among

关 键 词：微刺激方案 高孕激素状态下促排卵 卵巢低反应 性价比 体外受精-胚胎移植 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]