不同促排卵方案在高龄卵巢储备功能减退患者中的应用效果比较  

Application effect of different ovarian stimulation protocols in elderly patients with diminished ovarian reserve

作　　者：刘洋 南燕[1] 陈帆[1] 王慧[1] 李玉洁[1] LIU Yang;NAN Yan;CHEN Fan;WANG Hui;LI Yujie(Department of Reproductive Medicine,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China)

机构地区：[1]新乡医学院第三附属医院生殖医学科,河南新乡453003

出　　处：《新乡医学院学报》2020年第5期465-470,共6页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划项目(编号:201204060)。

摘　　要：目的比较不同促排卵方案在高龄卵巢储备功能减退(DOR)患者中的应用效果,为高龄DOR患者促排卵方案的选择提供参考。方法选择2016年12月至2019年7月于新乡医学院第三附属医院行体外受精-胚胎移植(IVF-ET)助孕的153例高龄DOR患者为研究对象,根据促排卵方案分为促性腺激素释放激素抑制剂(GnRHant)方案组(n=45)、微刺激方案组(n=56)、卵泡期高孕激素状态下促排卵(PPOS)方案组(n=52),分别给予相应的促排卵方案。采用阴道超声引导下穿刺取卵术进行取卵,进行IVF-ET,采用彩色超声诊断仪检测患者月经周期2~4 d双侧卵巢窦卵泡计数(AFC)、促排卵期间卵泡生长情况、冻融胚胎移植(FET)日子宫内膜厚度;采用全自动微粒子化学发光免疫系统检测患者月经周期2~4 d空腹静脉血血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E 2)、抗苗勒管素(AMH)及人绒毛膜促性腺激素(HCG)注射日LH、E 2、孕酮(P)水平;统计患者促性腺激素(Gn)应用时间、Gn使用总量、早发LH峰率、获卵数、第2次减数分裂(MⅡ)卵母细胞数、双原核(2PN)数、可利用胚胎数、未获胚率、周期取消率、优胚率、胚胎种植率、生化妊娠率、早期流产率、临床妊娠率。结果3组患者Gn应用时间、HCG注射日E 2和P水平及获卵母细胞数、MⅡ卵数、2PN数、可利用胚胎数、优胚率、未获胚率、周期取消率比较差异无统计学意义(F/χ^2=0.846、1.146、2.297、2.973、2.952、2.466、2.545、0.192、1.080、1.772,P>0.05)。3组患者Gn使用总量、HCG注射日LH水平及早发LH峰率比较差异有统计学意义(F/χ^2=7.050、14.389、7.131,P<0.05);其中GnRHant方案组患者Gn使用总量高于微刺激方案组、PPOS方案组(P<0.05);微刺激方案组患者早发LH峰率、HCG注射日LH水平高于GnRHant方案组、PPOS方案组(P<0.05)。GnRHant方案组、微刺激方案组、PPOS方案组患者有效FET周期率分别为60.00%(27/45)、53.57%(30Objective To compare the application effect of different ovarian stimulation protocols in elderly patients with diminished ovarian reserve(DOR)and provide reference for the selection of ovarian stimulation protocol in elderly patients with DOR.Methods A total of 153 elderly patients with DOR who were treated with in vitro fertilization and embryo transfer(IVF-ET)in the Third Affiliated Hospital of Xinxiang Medical University from December 2016 to July 2019 were selected as the study subjects.According to different ovarian stimulation protocols,they were divided into gonadotrophin-releasing hormone antagonis(GnRHant)protocol group(n=45),minimal stimulation protocol group(n=56)and progestin-primed ovarian stimulation(PPOS)protocol group(n=52).The patients in the three groups were given corresponding ovarian stimulation protocols.The oocytes were extracted by puncture under the guidance of vaginal ultrasound,and then IVF-ET were performed.The bilateral ovarian antral follicle count(AFC),follicle growth during ovarian stimulation and endometrial thickness on the day of freeze-thaw embryo transfer(FET)were measured with color ultrasound diagnostic instrument at 2-4 days of the menstrual cycle.The serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E 2)and anti-mullerian hormone(AMH)at 2-4 days of the menstrual cycle,and the levels of LH,E 2 and progesterone(P)on the day of injection of human chorionic gonadotrophin(HCG)were detected by automatic microparticle chemiluminescence immune system.The gonadotrophin(Gn)injection days,total dose of Gn using,early onset LH peak rate,the number of obtaining oocytes,the number of oocytes in the second meiotic division(MⅡ),double pronucleus(2PN)number,the number of available embryos,the failed embryo rate,cycle cancellation rate,the rate of superior embryo,embryo implantation rate,biochemical pregnancy rate,early abortion rate and clinical pregnancy rate were recorded.Results There was no statistically significant difference in the Gn injection days,E 2 and

关 键 词：卵巢储备功能减退 高龄 促性腺激素释放激素拮抗剂 促排卵 微刺激 

分 类 号：R715.9[医药卫生—妇产科学]