孕激素阻断方案在既往助孕失败患者中的应用  

Endogerous and exogenous progesterone used to block the LH surge during ovarian stimulation in the patients who failed to get pregnancy in IVF/ICSI-ET cycles

作　　者：郑华[1] 许伟标[1] 蔡桂丰[1] 杨嫦玉[1] 梁伟敏[1] ZHENG Hua;XU Wei Biao;CAI Gui Feng;YANG Chang Yu;LIANG Wei Min(Maternal and Child Health Care Hospital in Zhuhai,Zhuhai 519000,China)

机构地区：[1]广东省珠海市妇幼保健院,519000

出　　处：《中国妇幼卫生杂志》2020年第4期67-71,共5页Chinese Journal of Women and Children Health

摘　　要：目的探讨既往采用常规降调节长方案行体外受精/卵泡浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕失败的卵巢正常反应患者,改用孕激素阻断方案的临床效果。方法回顾性分析2018年9月-2019年3月于珠海市妇幼保健院行孕激素阻断方案促排卵的患者资料,从中筛选出既往曾行长方案促排卵,鲜胚移植周期及冻融胚胎移植(FET)周期均未获活产的卵巢正常反应的不孕患者共52人的病历资料。对照两种方案的促排卵、胚胎情况以及妊娠结局。结果孕激素阻断方案中Gn用量(2079.81±534.08)U显著低于长方案(2716.82±825.09)U(P<0.05);获卵数、MⅡ卵率及正常受精率与长方案比较差异无显著统计学意义(P>0.05),可利用胚胎数(2.82±1.91)个显著高于长方案(1.49±1.42)个(P<0.05),优质胚胎率略高于长方案,但差异无统计学意义(P>0.05)。其中,20例患者行FET,生化妊娠7例,临床妊娠9例,周期临床妊娠率45.00%,胚胎种植率34.38%,活产率35.00%均显著高于长方案(分别为14.29%、8.47%、0.00%),差异有统计学意义(P<0.05)。结论对于常规长方案促排卵后IVF/ICSI助孕失败的卵巢正常反应患者,孕激素阻断方案可获得较好的临床妊娠结局,为促排卵治疗提供了一种新的选择方案。Objective To explore the clinical effect of endogerous and exogenous progesterone used to block the LH surge during ovarian stimulation for IVF/ICSI in normal ovarian responders who failed to get live birth in the cycles with conventional long protocol.Methods The data of 52 normal ovarian responders who failed to get live birth with conventional long protocol,and then were administrated with endogerous and exogenous progesterone used to block the LH surge during ovarian stimulation as a new protocol in our center from Sep.2018 to Mar.2019 were analyzed retrospectively.The duration and the total dosage of gonadotropin(Gn)used,the number of oocytes retrieved,the rate of MⅡoocytes,fertilization and high quality embryos,the implantation rate,the clinical pregnancy rate and the live birth rate were compared between the two groups.Results The total dosage of Gn used[(2079.81±534.08)U vs.(2716.82±825.09)U]with progesterone used protocol were significantly less than those with conventional long protocol(P<0.05).Although the number of oocytes retrieved,the rate of MⅡoocytes and the fertilization rate were not significantly different(P>0.05),the number of available embryos[(2.82±1.91)vs.(1.49±1.42)]was significantly increased in progesterone used protocol cycles(P<0.05).The number of high quality embryos and the rate were increased in progesterone used protocol cycles,but there was no significant difference between the two groups(P>0.05).The clinical pregnancy rate(45.00%vs.14.29%),the implantation rate(34.38%vs.8.47%)and the live birth rate(35.00%vs.0.00%)were significantly improved in the FET cycles with progesterone used protocol(P<0.05).Conclusions The protocol that endogerous and exogenous progesterone used to block the LH surge during ovarian stimulation could provide better clinical outcomes for the patients with ovarian normal response but failed to get live birth with conventional long protocol in IVF/ICSI.It provides a new option for ovulation induction.

关 键 词：长方案 孕激素 卵巢刺激 体外受精-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]