不同刺激方案对卵巢低反应患者体外受精结局影响的比较  

Comparison of Different Stimulation Protocols on Pregnancy Outcome of Poor Ovarian Responders

作　　者：刘晓娉 王波 李婷婷[1] 黄睿[1] LIU Xiao-ping;WANG Bo;LI Ting-ting;HUANG Rui(Reproductive Medicine Center,The Sixth Affiliated Hospital of 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中心,广东广州510655

出　　处：《中山大学学报（医学版）》2018年第6期860-865,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：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】比较常规控制性卵巢刺激(COS)和微刺激方案在卵巢低反应(POR)患者行体外受精-胚胎移植(IVF-ET)中的临床结局。【方法】前瞻入组行体外受精/卵胞浆内单精子注射(ICSI)治疗的卵巢低反应患者随机分为两组,COS组选择促性腺激素释放激素激动剂(GnRH-a)修饰长方案,微刺激方案组选择来曲唑(LE)添加小剂量促性腺激素(Gn)行卵巢刺激,比较两组患者促排效果及临床妊娠结局差异。【结果】COS组患者扳机日子宫内膜厚度(mm)和扳机日血清雌二醇(E2)水平(pg/mL)显著高于微刺激组,分别为11.4±2.5 vs. 9.6±2.5、1200±710 vs. 560±470,差异均有统计学意义(P<0.05);两组扳机日血清黄体生成素(LH)、孕激素(P)水平差异无统计学意义(P>0.05);COS组患者获卵数(4.1±2.8 vs. 2.8±1.9)和可利用胚胎数(2.0±1.6 vs. 1.5±1.4)均多于微刺激组,差异有统计学意义(P<0.05);两组的胚胎种植率,每移植周期、每取卵周期以及每启动周期的临床妊娠率,流产率,活产率差异均无统计学意义(P>0.05)。【结论】在POR患者促排治疗中,微刺激方案和COS方案相比有相近的临床妊娠率。而微刺激方案可节约Gn用量、缩短促排卵时间。因此微刺激方案是POR患者较理想的促排卵方案。【Objective】To compare the effect of the conventional controlled ovarian stimulation(COS)and mild stimulation protocol in poor ovarian responders(POR)undergoing IVF/ICSI.【Methods】A prospective randomized study was performed in 191 patients with POR undergoing in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI).The patients were randomized into two groups,modified long protocol was applied in COS group,while letrozole compensated with low dose gonadotropin protocol was applied in mild stimulation group.The clinical outcomes were compared between these two groups.【Results】Comparing with COS group,both endometrium thickness and serum E2 level on the trigger day were significantly lower in the mild stimulation group[(9.6±2.5)vs(11.4±2.5)mm,(560±470)vs(1200±710)pg/mL,P<0.05].No significant difference was found between the two groups in the serum LH and P levels on the trigger day(P>0.05).Although the number of oocytes retrieved[(4.1±2.8)vs(2.8±1.9),P<0.05]and the number of available embryos[(2.0±1.6)vs(1.5±1.4),P<0.05]were significantly higher in the COS group,similar embryo implantation rate,clinical pregnancy rate per embryo transfer,per OPU and per initiation cycle,abortion rate and live birth rate were observed in both groups.【Conclusion】For POR patients,the COS protocol and the mild stimulation protocol yield a similar clinical pregnancy rate.Considering the fewer Gn dosage and shorter ovarian stimulation length associated with the letrozole mild stimulation,it can be concluded that the letrozole mild stimulation protocol is an ideal ovulation induction regimen for POR patients.

关 键 词：控制性卵巢刺激 GnRH-a修饰长方案 微刺激方案 卵巢低反应 临床妊娠率 

分 类 号：R715.2[医药卫生—妇产科学]