间歇停药方案与小卵泡穿刺对高反应患者IVF-ET临床结局影响的比较研究  

A comparative study on the effects of intermittent drug withdrawal and small follicle aspiration on clinical outcomes in COH high-responders

作　　者：杨军[1] YANG Jun(Center of Clinical Reproductive Medicine,Shantou Central Hospital,Shantou 515031,China)

机构地区：[1]汕头市中心医院生殖中心

出　　处：《中国实用妇科与产科杂志》2019年第7期815-819,共5页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨在行体外受精-胚胎移植(IVF-ET)的患者中,采用降调方案超促排卵(COH)的早、中期即出现高反应患者的处理策略。方法回顾性分析2017年6月至2018年6月在汕头市中心医院生殖中心行IVF-ET的127例早、中期出现高反应的患者资料,根据处理对策分为间歇停药组(A组)、小卵泡穿刺组(B组)、未行这2种处理的对照组(C组),比较3组间的胚胎质量、妊娠结局、卵巢过度刺激综合征(OHSS)的发生率、取消新鲜移植周期数等。并进一步比较间断停药1次(A1组)与2~3次(A2组),停药1 d(A3组)与2~3 d(A4组)的胚胎质量、妊娠结局。结果间歇停药组、小卵泡穿刺组hCG日雌二醇(E2)值、OHSS发生率、取消新鲜移植周期率、流产率低于对照组(P<0.05),优胚率高于对照组(P<0.05);3组之间的妊娠率没有明显差异(P>0.05)。A1组与A2组,A3组与A4组的胚胎质量、妊娠结局没有明显差异(P>0.05)。结论间歇停药方案无创、安全、简便,能提高胚胎质量,是高反应患者提高新鲜移植机会的适用方案。Objective To explore the treatment strategy for patients with hyperresponsiveness in the early and middle stages of superovulation induction(COH)by GnRH agonist down-regulation protocol in in vitro fertilization-embryo transfer(IVF-ET).Methods An analysis was made in 127 cases of IVF-ET performed in Reproductive Center of Shantou Central Hospital from June 2017 to June 2018.The patients were divided into 3 groups according to the different treatment:intermittent drug withdrawal group(group A),small follicle aspiration group(group B),and control group(group C).The embryo quality,pregnancy outcome,incidence of ovarian hyperstimulation syndrome(OHSS)and the number of cancelled fresh transplantation cycles were compared among the three groups.The embryo quality and pregnancy outcome was further compared between discontinuous withdrawal once(A1 group)and 2-3 times(A2 group),and between 1 day(A3 group)and 2-3 days(A4 group).Results The E2 level on HCG day,the rate of moderate and severe OHSS,cancellation rate and miscarriage rate in group A and group B were significantly lower than those in group C(P<0.05),but high-quality embryos rate was significantly higher than group C(P<0.05).There was no significant difference in clinical pregnancy rate among the three groups(P>0.05).There was no significant difference in embryo quality or clinical outcomes between group A1 and A2,and between group A3 and A4(P>0.05).Conclusion The intermittent withdrawal regimen is non-invasive,safe and simple,and can improve the quality of embryos.It is a suitable regimen for high-response patients to improve the chance of fresh transplantation.

关 键 词：超促排卵 体外受精-胚胎移植 间歇停药方案 小卵泡穿刺 

分 类 号：R323.21[医药卫生—人体解剖和组织胚胎学]