高孕激素下促排卵方案与黄体期长方案用于平衡易位PGD周期治疗效果的比较  

Comparison of the preimplantation genetic diagnosis efficacy between progestin-primed ovarian stimulation protocol and luteal phase long-acting protocol for balanced chromosome translocation carriers

作　　者：彭佳丽 李风和[1,2] 李洁 程丹[1,2] 肖卓妮 PENG Jiali;LI Fenghe;LI Jie;CHENG Dan;XIAO Zhuoni(Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China;Clinic Research Center for Assisted Reproductive Technology and Embryonic Development of Hubei Province, Wuhan 430060, Hubei, China)

机构地区：[1]武汉大学人民医院生殖医学中心,武汉430060 [2]湖北省辅助生殖与胚胎发育医学临床研究中心,武汉430060

出　　处：《中国性科学》2019年第10期41-45,共5页Chinese Journal of Human Sexuality

基　　金：国家自然科学基金项目(81100418);国家自然科学基金项目(81471455);国家自然科学基金项目(81501427)

摘　　要：目的探讨高孕激素下促排卵方案和黄体期长方案对平衡易位携带行PGD周期治疗效果的比较。方法回顾性分析2016年5月至2018年4月在武汉大学人民医院生殖医学中心因染色体平衡易位行PGD助孕的51例患者的临床资料,根据患者促排卵方案的不同将其分为高孕激素下促排卵方案组(PPOS方案组)和黄体期长方案组(LP方案组),其中PPOS方案组24例患者,LP方案组27例患者。比较两组患者的一般特点、促排卵情况、胚胎发育情况和子代胚胎染色体情况。结果两组患者的一般情况,包括双方年龄、不孕年限、BMI、基础窦卵泡数、基础FSH、基础LH、FSH/LH比值和基础E2比较,其差异均无统计学意义(均P>0.05)。促排卵过程中,PPOS方案组患者促排天数显著低于LP方案组患者(9.21±1.67 vs 11.22±2.87,P=0.003),PPOS方案组患者获卵数少于LP方案组患者[10.50(8.25,17.50)vs 14.00(12.00,20.00),P=0.096)],PPOS方案组患者M2卵子数少于LP方案组患者[9.50(7.00,13.00) vs 12.00(8.00,18.00),P=0.219)],PPOS方案组患者2PN数少于LP方案组患者[8.00(6.00,12.00) vs 9.00(5.00,14.00),P=0.583)],PPOS方案组患者第5天囊胚比例高于LP方案组患者(56.12%vs 45.65%,P=0.149),两组差异均无统计学意义;但PPOS方案组患者可活检囊胚形成率显著高于LP方案组患者(44.34%vs 34.40%,P=0.023),其差异具有统计学意义。两组患者胚胎染色体形成情况中,正常/平衡胚胎比例(32.65%vs 36.08%,P=0.614))、不平衡胚胎比例(40.82%vs 32.99%,P=0.495))、非整倍体胚胎比例(37.76%vs 41.24%,P=0.619))等比较,其差异均无统计学意义。2种方案均有约30%的患者无可移植胚胎(29.17%vs 29.63%,P=0.971)。结论对于染色体平衡易位行PGD助孕的患者,PPOS方案能够获得与黄体期长方案相似的促排卵效果,而且可活检囊胚形成率更高。通过分析二代测序结果显示,PPOS方案对子代染色体形成没有不利影响。所以,对于染色体平衡易位行PGD�Objective To compare the preimplantation genetic diagnosis(PGD) efficacy between progestin-primed ovarian stimulation(PPOS) protocol and luteal phase long-acting protocol(LP) for balanced chromosome translocation carriers. Methods A retrospective study was performed including 51 cycles which were undergoing preimplantation genetic diagnosis for balanced chromosome translocation carriers. These patients received PGD treatment from May 2016 to April 2018. Among them, 24 cycles were given PPOS protocol(PPOS Group) and 27 cycles were given LP(LP Group). The clinical characteristic of patients, the efficacy of the controlled ovarian hyperstimulation(COH) and the chromosome formation status during meiosis were compared between the two groups. Results The general conditions of patients in the two groups, including age, infertility years, BMI, basal antral follicle counting, basal FSH, basal LH, ratio of basal FSH/basal LH and basal E2, showed no statistical significance(all P>0.05). During ovulation induction, the number of ovulation induction days in the PPOS group was significantly lower than that in the LP group(9.21±1.67 vs 11.22±2.87, P=0.003). The number of eggs in the PPOS group was lower than that in the LP group [10.50(8.25, 17.50) vs 14.00(12.00,20.00), P=0.096]. And the number of M2 eggs in the PPOS group was lower than that in the LP group [9.50(7.00, 13.00) vs 12.00(8.00, 18.00), P=0.219]. PPOS group had less 2 PN than LP group [8.00(6.00, 12.00) vs 9.00(5.00, 14.00), P=0.583)], and PPOS group had a higher percentage of blastocyst on day 5 than LP group(56.12% vs 45.65%, P=0.149). The difference between the two groups was not statistically significant. However, the biopsy blastocyst formation rate in PPOS group was significantly higher than that in LP group(44.34% vs 34.40%, P=0.023), and the difference was statistically significant. In terms of embryonic chromosome formation in both groups, the ratio of normal/balanced embryo(32.65% vs 36.08%, P=0.614), unbalanced embryo(40.82% vs 32.99%, P=0.495) and an

关 键 词：染色体相互易位 PPOS方案 黄体期长方案 胚胎植入前遗传学诊断 二代测序 

分 类 号：R711[医药卫生—妇产科学]