轻微型和控制型卵巢刺激对卵巢低反应患者卵泡液微环境的不同影响  

Hormonal Profile of Follicular Fluid between Mild Stimulation and Controlled Ovarian Hyperstimulation IVF Cycles in POR Patients

作　　者：李婷婷[1] 张晓莉[1] 黄睿[1] LI Ting-ting;ZHANG Xiao-li;HUANG Rui(Reproductive Medicine Research Center,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院生殖医学研究中心,广东广州510655

出　　处：《中山大学学报（医学版）》2018年第5期736-741,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科学基金(A2015025);国家重点研发计划"生殖健康及重大出生缺陷防控研究"重点专项课题(2016YFC1000302)

摘　　要：【目的】比较卵巢低反应患者进行卵巢轻微刺激和控制性卵巢刺激体外受精-胚胎移植(IVF-ET)周期中卵泡液内激素水平、细胞因子的差异及其与获卵数、胚胎数等的关系。【方法】本研究为观察性研究。招募符合博洛尼亚标准的卵巢低反应患者,随机分为实验组(组2)和对照组(组1)。实验组采用来曲唑及低剂量外源性促卵泡生成素(Gn)进行卵巢轻微刺激,对照组采用常规控制性卵巢刺激(黄体期GnRH激动剂修饰长方案)进行卵巢刺激。于取卵日收集成熟卵泡(>16 mm)的卵泡液,其中实验组共23例,对照组共28例,测量卵泡液中促卵泡生成素(FSH)、促黄体生成素(LH)、雌激素(E2)、孕激素(P)、睾酮(T)和抗苗勒管激素(AMH)水平,以及抑制素(inhibin)、生长分化因子9(GDF9)和骨形成蛋白家族(BMP)水平。统计分析卵泡液中各激素、因子水平与获卵数、可利用胚胎数及优质胚胎数的相关性。【结果】实验组和对照组患者基本情况各指标之间:年龄、不孕年限、基础FSH、和窦卵泡数(AFC)差异均无显著性意义(P>0.05)。与对照组相比,实验组Gn用量更少,但两组的获卵数,可利用胚胎数及优质胚胎数差异均无统计学意义(P>0.05)。与对照组相比,实验组卵泡液中LH水平、睾酮水平和inhibin B水平明显增高,而FSH水平、inhibin A水平、BMP8B和GDF9水平明显降低。其他几种激素水平,包括E2、P、AMH和BMP2、6、8B、15水平,两组间差异无显著性意义(P>0.05)。相关分析显示,卵泡液中各激素和细胞因子水平均与获卵数、可移植胚胎数及优质胚胎数无相关性。【结论】POR患者使用不同的轻微刺激和常规控制性卵巢刺激,卵泡微环境不同。但未发现这些变化与获卵数、可利用胚胎数、优质胚胎数存在相关性。【Objective】To compare the hormonal milieu of follicular fluid from pre-ovulatory follicles between mild stimulation and controlled ovarian hyperstimulation(COH)in-vitro fertilization(IVF)cycles in poor ovarian response(POR)patients.【Methods】From August to November 2014,follicular fluid was prospectively collected from 51 POR patients undergoing IVF treatment stimulated with mild stimulation(n=23)or COH(GnRH agonist long“stop”protocol,n=28),Follicular fluid(FF)was collected from one follicle larger than 16 mm and intra-follicular FSH,LH,estradiol(E2),progesterone(P),testosterone(T)and anti-mullerian hormone(AMH)levels were assayed.The differences in FF hormonal profile between two groups were compared and the correlation between each identical hormonal level and num-ber of oocytes retrieved,transferrable embryos or good-quality embryos was evaluated.【Results】The differences in basic characteristics,such as age,AFC,basal FSH,E2,LH and AMH levels between two groups had no statistical signifi-cant meaning.The dose of Gn consumption was significantly higher in COH group,while the number of oocyte re-trieved,transferrable embryo and good quality embryo were same in two groups.Comparing with COH group,the FF LH and T levels were significantly higher,while the FSH,inhibin A,BMP 8B and GDF 9 level were significantly lower in mild stimulation group.No significant difference was observed in other hormones,including E2,P,AMH and BMP2/6/8A/15.None of these hormones was found to be correlated with the number of oocyte retrieved,transferrable embryos,or good quality embryos(all with P>0.05).【Conclusions】Comparing with COH group,the intra-follicular LH,T and inhibin B were significantly higher,while FSH level was lower in mild stimulation group.No significant difference was observed in E2,P,AMH and BMP2/6/8A/15 levels between two groups.The distinction of intra-follicular hormone profiles indicated that follicular microenvironment was varied between mild stimulation and COH,which might conse-quently have impa

关 键 词：卵巢轻微刺激 卵巢低反应 卵泡液微环境 

分 类 号：R711.75[医药卫生—妇产科学]