卵巢储备功能减退患者月经期取卵行IVF/ICSI-ET的可行性分析  

Feasibility of egg retrieval during menstruation period in women with diminished ovarian reserve undergoing IVF/ICSI-ET

作　　者：金武敏 林佳[1] 金聪聪[1] 陈霞[1] JIN Wumin;LIN Jia;JIN Congcong(Reproductive Medicine Center,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325100,China)

机构地区：[1]温州医科大学附属第一医院生殖医学中心

出　　处：《浙江医学》2019年第21期2297-2300,2304,共5页Zhejiang Medical Journal

摘　　要：目的探讨月经期取卵在卵巢储备功能减退(DOR)患者中行体外受精/单精子卵胞浆内注射-胚胎移植术(IVF/ICSI-ET)的可行性。方法回顾性分析2014年6月至2017年6月行IVF/ICSI-ET治疗的44例DOR患者资料,依据有无月经期优势卵泡进行分组,若月经第2~5天阴道超声提示优势卵泡直径≥14 mm则纳入月经期组,若无优势卵泡则纳入拮抗剂组。月经期组在当晚行人绒毛膜促性腺激素(HCG)注射后36h行取卵术,拮抗剂组按常规促排卵后行取卵术。月经期组患者胚胎行全胚冷冻,于下一周期行冻融胚胎移植(FET),拮抗剂组患者按本中心常规进行移植。比较两组间的周期取消率、获卵数、正常受精卵数、优质胚胎数、获卵率、受精率、优质胚胎率、临床妊娠率等。结果拮抗剂组及月经期组的周期取消率分别为23.1%(6/26)及5.6%(1/18),拮抗剂组的获卵数、受精数、优胚数分别为(3.42±2.06)、(2.67±1.81)、(1.71±1.55)个,月经期组获卵数、受精数、优胚数分别为(1±0.34)、(0.72±0.57)、(0.5±0.62)个,差异均均有统计意义(均P<0.05),月经期组的获卵率、受精率、优胚率、临床妊娠率分别为94.4%(17/18)、76.5%(13/17)、69.2%(9/13)、35.0%(7/20),拮抗剂组的获卵率、受精率、优胚率、临床妊娠率分别为78.0%(64/82)、79.7%(51/64)、80.4%(41/51)、50.0%(3/6),差异均无统计学意义(均P>0.05)。结论月经期取卵的获卵数、优质胚胎数等小于拮抗剂组,但其周期取消率低于拮抗剂组,卵子成熟率以及临床妊娠率较拮抗剂组高,虽不能作为DOR患者IVF/ICSI-ET周期治疗首选,但可有一定的获卵数且能获得一定的可用优质胚胎数,为原本应取消周期的DOR患者节省了治疗时间,提供了新的治疗思路,是一种切实可行的IVF/ICSI-ET周期治疗方案。Objective To explore the feasibility of egg retrieval during menstruation period in women with diminished ovarian reserve(DOR) undergoing in-vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).Methods From June 2014 to June 2017, 44 women diagnosed with DOR undergoing IVF/ICSI-ET in Reproductive Medicine Center, the First Affiliated Hospital of Wenzhou Medical College were enrolled in the study. Patients with dominant follicle ≥14 mm at d2~d5 of menstruation indicated by transvaginal ultrasound were scheduled for egg retrieval(menstruation group);otherwise patients were scheduled to receive Gn RH antagonist(GnRH-A) protocol(GnRH-A protocol group). The whole embryo frozen was manipulated, and the frozen-thawed embryo transfer(FET) was performed in the next cycle for menstruation group;for control group the patients were followed the routine protocol of the center. The number of oocytes retrieved, mature oocytes,fertilization rate, high qualified embryo rate were documented and compared between two groups. Results The cycle cancellation rates of the Gn RH-A protocol group and the menstruation group were 23.1%(6/26) and 5.6%(1/18), respectively. The number of oocytes retrieved, mature oocytes and high qualified embryos in menstruation group were(1±0.34),(0.72±0.57) and(0.5±0.62), respectively, while those in Gn RH-A protocol group were 3.42±2.06, 2.67±1.81 and 1.71±1.55, respectively(P<0.05). There were significant differences in oocyte retrieval rate, cleavage rate, high qualified embryo rate and clinical pregnancy rate between menstruation group [94.4%(17/18), 76.5%(13/17), 69.2%(9/13), 35.0%(7/20)] and Gn RH-A protocol group [78.0%(64/82), 79.7%(51/64), 80.4%(41/51)and 50.0%(3/6)](P >0.05). Conclusion The number of oocytes retrieved, mature oocytes and viable embryos in menstruation group are lower than those in Gn RH-A protocol group, but it can reduce the cycle cancellation rate, The egg retrieval in menstruation period may not be the first choice for DOR women, but it

关 键 词：月经期 拮抗剂方案 卵巢储备功能减退 

分 类 号：R71[医药卫生—妇产科学]