甲羟孕酮方案在高龄卵巢储备功能减退患者中的应用及效果分析  

Clinical effect analysis of medroxyprogesterone acetate protocol in the elderly patients with decreased ovarian reserve patients

作　　者：刘文霞[1] 王碧君 杜明泽 刘曼曼[1] 李嘉恒[1] 管一春[1] 张俊韦 王兴玲[1] LIU Wenxia;WANG Bijun;DU Mingze;LIU Manman;LI Jiaheng;GUAN Yichun;ZHANG Junwei;WANG Xingling(Reproductive Center,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院生殖中心,郑州450052

出　　处：《河南大学学报（医学版）》2020年第1期30-34,共5页Journal of Henan University:Medical Science

基　　金：河南省医学科技攻关项目(201702110)。

摘　　要：[目的]分析甲羟孕酮方案(MPA)与克罗米芬联合来曲唑方案(CC+LE)在高龄卵巢功能减退(DOR)患者中的临床应用效果,探索高龄DOR患者最优的控制性促排卵(COH)方案。[方法]回顾性分析2017年5月至2018年5月在郑州大学第三附属医院生殖中心行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕的高龄DOR患者共781个周期,根据促排卵方案分为克罗米芬联合来曲唑组(A组,CC+LE)458个周期和甲羟孕酮组(B组,MPA)323个周期,并对其中61例进行自身对照观察,比较两种方案促排卵的临床效果。[结果]两组患者一般资料比较B组患者既往周期数、基础卵泡刺激素(FSH)高于A组,而基础窦卵泡数及抗穆勒氏管激素(AMH)低于A组(P<0.05)。B组的Gn总量、Gn总天数高于A组,差异均有统计学意义(P<0.05);B组HCG日E2水平高于A组,LH水平低于A组,获卵数少于A组,差异均有统计学意义(P<0.05);B组的周期取消率及早发LH峰率均低于A组,差异有统计学意义(P<0.05);两组成熟卵泡数、可利用胚胎及优质胚胎数、优胚率等方面无统计学差异(P>0.05);B1组周期取消率,低于A1组且可利用胚胎数高于A1组(P<0.05)。[结论]MPA方案能有效降低高龄DOR患者早发LH峰率及周期取消率,提高可利用胚胎数。MPA方案与CC+LE方案相比更适合高龄DOR患者。[Objective]to analyze the clinical effect of medroxyprogesterone acetate(MPA) and clomiphene combined with letrozole(CC+LE) in the elderly patients with decreased ovarian reserve(DOR), and to find the optimal controlled ovarian hyperstimulation(COH) regimen for the elderly patients.[Methods]To analysis retrospectively the clinical data of 781 cycles that received in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET) patients with DOR in Third Affiliated Hospital Reproductive Center of Zhengzhou University from May 2016 to May 2017. According to the ovulation protocol, we divided them into the following groups:MPA(group A,n=458);clomiphene combined with letrozole(group B,n=323);Two methods were applied in 61 patients and the results were compared.Then they were treated with MPA protocol(group B1).And we compared the differences between two groups groups and the self-control group in clinical outcomes. [Results]General data of patients in the two groups were compared. The number of previous cycles and basal follicle stimulating hormone(FSH) in group B was higher than those in group A, while the number of antrol follicle count(AFC) and AMH in group B was lower than those in group A(P<0.05);The duration and total dosage of Gn used in group B were significantly higher than those in group A(P<0.05);The level of estradiol was higher while the level of LH was lower on HCG trigger day and the number of the oocytes retrieved was higher in group B than those in group A(P<0.05);The early LH surge, and cancellation rate were much lower in group B than ingroup A(P<0.05);There were no differences in number of mature oocyte,utilized embryos, high-quality embryos and the rate of high-quality embryos(P>0.05). Self-control study found that the cycle cancellation rate of group B1 was lower than that of group A1, and the number of available embryos was higher than that of group A1(P<0.05).[Conclusion]Conclusion] MPA can effectively reduce the early LH surge rate and cycle cancellation rate of eleder

关 键 词：甲羟孕酮 控制性促排卵 卵巢储备功能减退 

分 类 号：R711.7[医药卫生—妇产科学]