小剂量GnRH-a诱发后的促排卵方案在卵巢低储备患者高基础雌激素状态下的应用  

An ovarian stimulation protocol after low-dose GnRH agonist trigger in diminished ovarian reserve patients with high basal estradiol level

作　　者：秦宁馨[1] 沈曦 郜虹媛[1] 叶静[1] 朱秀娴[1] 吕祁峰[1] 陈秋菊[1] 匡延平[1] QIN Ning-xin;SHEN Xi;GAO Hong-yuan;YE Jing;ZHU Xiu-xian;LU Qi-feng;CHEN Qiu-ju;KUANG Yan-ping(Reproductive Medicine Department,Shanghai Ninth People s Hospital Affiliated to Shanghai JiaoTong University School of Medicine,Shanghai 200011;Shanghai JiaoTong University School of Medicine,Shanghai 200020)

机构地区：[1]上海交通大学医学院附属第九人民医院

出　　处：《生殖医学杂志》2019年第8期878-885,共8页Journal of Reproductive Medicine

基　　金：国家自然科学基金(81571397,81771533)

摘　　要：目的探讨一种小剂量GnRH-a诱发后新的促排卵方案,在卵巢低储备(DOR)患者高基础雌激素(basal estrodial,B-E 2)状态下应用的可行性。方法回顾性分析2015年1月至2017年1月期间在上海市第九人民医院助孕的50例DOR患者所行的IVF/ICSI周期,采用自身对照。当B-E2≥275.3pmol/L伴或不伴优势卵泡出现时,应用小剂量GnRH-a诱发后促排卵方案,并纳入实验组;当B-E2<275.3 pmol/L且月经期无优势卵泡出现,应用常规治疗方案,并纳入对照组,同时依据采用方案的不同分为3个亚组:卵泡期对照组、黄体期对照组和自然周期对照组。观察不同组的临床结局。结果实验组、卵泡期对照组、黄体期对照组和自然周期对照组四组间卵子利用率、胚胎种植率和临床妊娠率无统计学差异(P>0.05)。实验组、卵泡期对照组和黄体期对照组三组间可用胚胎数、周期取消率无统计学差异(P>0.05);自然周期对照组冷冻胚胎总数低于实验组、卵泡期对照组和黄体期对照组[(0.2±0.1)vs.(1.8±1.7)vs.(1.5±1.3)vs.(1.0±0.3)],差异有显著性(P<0.05);自然周期对照组周期取消率高于实验组、卵泡期对照组和黄体期对照组三组,差异有显著性(82.4%vs.24.0%vs.26.1%vs.47.4%,P<0.05)。结论当DOR患者出现高基础雌激素状态时,除直接取消周期外,可尝试应用小剂量GnRH-a诱发后的卵巢促排卵方案,可达到与卵泡期促排卵、黄体期促排卵相类似的临床结局。为反复周期取消的DOR患者节约了治疗时间,提供了新的促排卵方法。Objective:To investigate the feasibility of a new ovarian stimulation protocol after low-dose GnRH agonist(GnRH-a)trigger in diminished ovarian reserve(DOR)patients with high basal estradiol level.Methods:The data of 50 DOR patients undergone IVF/ICSI in Shanghai Ninth People’s Hospital from Jan 2015 to Jan 2017 were retrospectively analyzed.It was a self-control study.When basic E 2≥275.3 pmol/L and without dominant follicle,the patients were treated with an ovarian stimulation protocol after low-dose GnRH agonist(GnRH-a)trigger as the experiment group.When basic E 2<275.3 pmol/L and without dominant follicle,the patients were treated with routine treatment protocol as the control group.The patients in control group were subdivided are three groups recording to the different ovarian stimulation protocols:follicular phase control group,luteal phase control group and natural cycle control group.Results:No significant differences were found in oocyte utilization rate,embryo implantation rate and clinical pregnancy rate among the experiment group,follicular phase control group,luteal phase control group and natural cycle control group(P>0.05).There were no significant differences in number of available embryos and cycle cancellation rate among the experiment group,follicular phase control group and luteal phase control group(P>0.05).The total number of frozen embryos in natural cycle control group(0.2±0.1)was significantly lower than that in the experiment group(1.8±1.7),follicular phase control group(1.5±1.3)and luteal phase control group(1.0±0.3)(P<0.05).The cycle cancellation rate in natural control group(82.4%)was significantly higher than the experiment group(24.0%),follicular phase control group(26.1%)and luteal phase control group(47.4%)(P<0.05).Conclusions:When DOR patients have a high basal estrogen level,they can be tried to apply ovarian stimulation protocol after low-dose of GnRH-a trigger unless the cycle is cancelled directly.It can achieve similar clinical outcomes of ovulation induction in fo

关 键 词：卵巢低储备 高基础雌激素 小剂量GnRH-a 周期取消率 

分 类 号：R711.6[医药卫生—妇产科学]