两种高孕激素状态下促排方案在卵巢低反应患者中的应用比较  

Comparison of luteal-phase ovarian stimulation(LPOS) with progestin primed ovarian stimulation(PPOS) for ovulation induction in poor ovarian responders

作　　者：杨榃楚 陈豪英 习海涛 赵军招 YANG Tanchu;CHEN Haoying;XI Haitao(Center of Reproductive Medicine, The Second Affiliated Hospital/Yuying Children’s Hospital of Wezhou Medical University, Wenzhou 325027, China)

机构地区：[1]温州医科大学附属第二医院、育英儿童医院生殖中心,325027

出　　处：《浙江医学》2018年第24期2642-2646,共5页Zhejiang Medical Journal

基　　金：温州市科技局计划项目(Y20160008)

摘　　要：目的比较两种高孕酮方案即高孕激素环境下超促排卵方案(PPOS)和黄体期促排卵方案(LPOS)在卵巢低反应患者(POR)中的应用效果。方法回顾性分析2016年1月至2016年12月205个体外受精/卵胞浆内单精子显微注射技术-胚胎移植周期。根据用药方式不同分为两组,PPOS 138个周期,LPOS 67个周期。比较两组促排卵结果、实验室相关指标及临床妊娠结局。结果两组年龄、获卵数、D3优质胚胎数比较差异均无统计学意义(均P>0.05)。PPOS方案较LPOS方案触发日促黄体生成素(LH)水平更高(P<0.05),而触发日孕酮(P)水平、Gn总量、卵子成熟率则更低(P<0.05)。两组优质胚胎率、后期冻融胚胎移植的临床妊娠率比较差异均无统计学意义(均P>0.05)。两组中均未发生早发LH峰和卵巢过度刺激综合征。结论 LPOS和PPOS均能使POR患者获得理想的优胚率以及冻融胚胎移植临床妊娠率,两种方案均适用于POR患者,使促排卵受月经周期影响减小,启动时间更加灵活。Objective To compare the luteal-phase ovarian stimulation(LPOS) with progestin primed ovarian stimulation(PPOS)for ovulation induction in poor ovarian responders. Methods From January 2016 to December 2016, 205 IVF/ICSI cycles were performed,among which PPOS protocol was adapted in 138 cycles(PPOS group) and LPOS protocol was adapted in 67 cycles(LPOS group). The induce ovulation results, laboratory indicators and pregnant outcomes were compared between two groups. Results There were no significant differences in age, the number of retrieved oocytes and D3 high quality embryos between two groups(P >0.05). The LH level of trigger day was higher in PPOS group(P<0.05), the dose of Gn and progesterone level and mature oocytes rate were much lower than those in LPOS group during progestin primed ovarian stimulation. No significant difference was found in good-quality embryos rate(55.75% vs58.39%) and clinical pregnancy rate(21.35% vs 18.37%) between two groups(P >0.05). No premature LH surge and OHSS occurred in either group. Conclusion Both LPOS and PPOS protocols can achieve ideal good-quality embryos rate and clinical pregnancy rate of first frozen-thawed embryo transfer in women with poor ovarian response.

关 键 词：黄体期促排卵 卵泡期高孕激素 卵巢低反应 冻融胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]