不同促排卵方案对卵巢储备功能减退的子宫内膜异位症患者妊娠结局的影响  

Effect of different ovarian stimulation protocols on the clinical outcome of endometriosis patients with diminished ovarian reserve

作　　者：郑娟[1] 蔡嘉力[1] 刘兰兰[1] 郭岩文 任建枝[1] ZHENG Juan;CAI Jia-li;LIU Lan-lan;GUO Yan-wen;REN Jian-zhi(Center of Reproductive Medicine,174th Hospital of PLA,Xiamen,China,361000)

机构地区：[1]中国人民解放军第一七四医院生殖中心

出　　处：《中国优生与遗传杂志》2019年第11期1384-1386,1393,共4页Chinese Journal of Birth Health & Heredity

基　　金：厦门市科技计划项目(3502Z20184065)

摘　　要：目的探讨不同促排卵方案对卵巢储备功能减退的子宫内膜异位症(endometriosis,EMs)患者行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)/卵胞浆内单精子显微注射(intracytoplasmic sperm injection,ICSI)妊娠结局的影响。方法回顾性分析中国人民解放军第一七四医院生殖中心2012年7月至2017年12月行IVF/ICSI治疗的子宫内膜异位症患者的临床资料,共346个周期,分为超长方案组、改良长方案组和拮抗剂方案组,比较3组不同方案的实验室指标和临床结局。通过多因素logistic回归分析不同方案对活产的影响。通过广义线性模型讨论不同方案对卵巢反应和妊娠结局的影响。结果拮抗剂方案组促性腺激素(gonadotrophin,Gn)使用总量和刺激天数均显著低于超长方案组和改良长方案组(P<0.005);超长方案组和改良长方案组获卵数、胚胎种植率、临床妊娠率和活产率较拮抗剂方案组显著增高(P<0.005);校正年龄、窦卵泡数(antral follicle count,AFC)、卵泡刺激素(folliclestimulating hormone,FSH)、体重指数(body mass index,BMI)、获卵数、HCG日内膜厚度、移植胚胎数等混杂因素之后,多因素分析显示,改良长方案组的活产率显著高于拮抗剂方案组(OR0.316,95%CI:0.143-0.699),而与超长方案组相比无明显差异(OR 0.677,95%CI:0.348-1.317)。校正年龄、AFC、FSH、体重指数、Gn启动剂量、Gn天数及EMs分期等因素后,广义线性模型显示,改良长方案组获卵数较拮抗剂方案组显著增加(P<0.005)。结论卵巢储备功能减退的子宫内膜异位症患者使用改良长方案较拮抗剂方案活产率更高,可获得与超长方案相似的妊娠结局。Objective:To investigate the effect of different ovarian stimulation protocols on the clinical outcome of in IVF/ICSI in endometriosis patients with diminished ovarian reserve.Methods:The clinical data of 346 patients with endometriosis who underwent in IVF/ICSI in the reproductive center of 174 th Hospital of PLA from July 2012 to December 2017 was analyzed retrospectively.The cycles were divided into ultra-long protocol group,modified long protocol group and antagonist protocol group.The laboratory outcome and clinical outcome were statistically compared between the groups.Multivariate logistic regression was used to analyze the effect of protocols on live birth.Generalized linear model was used to evaluate the effect of protocols on the numbers of oocytes retrieved.Results:The Gn doses and stimulation days were significantly lower in antagonist protocol group(P<0.05).The numbers of oocytes retrieved,implantation rate,clinical pregnancy rate and live birth rate were significantly higher in ultra-long protocol group and modified long protocol(P<0.05).Adjusted for confounding factors including age,AFC,FSH,BMI,endometrial thickness on the day of hCG,oocyte yield and embryo transfer parameters,the logistic regression model suggested that live birth rates in antagonist protocol group were significantly lower than that in modified long protocol group(Odds ratio 0.316,95%confidence interval:0.143-0.699),but there was no significant difference in the live birth rates between patients in the ultra-long protocol group and modified long protocol group(Odds ratio 0.677,95%confidence interval:0.348-1.317).Adjusted for confounding factors including age,AFC,FSH,BMI,Gn days,initial Gn doses and the stages of the endometriosis,the Generalized linear model suggested that the modified long protocol achieve higher oocyte yield than GnRH antagonist protocol(P<0.05).Conclusion:In endometriosis patients with diminished ovarian reserve,the modified long protocol may achieve higher live birth rate than GnRH antagonist protocol and have

关 键 词：卵巢储备功能减退 子宫内膜异位症 改良长方案 体外受精-胚胎移植 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]