高孕激素促排卵方案在FSH水平升高的卵巢低反应患者助孕治疗中的应用  

Application of progestin-primed ovarian stimulation protocol in assisted pregnancy treatment of patients with pore ovarian response and elevated FSH level

作　　者：王力[1] 周雪源[1] 姜洁思[1] 闻姬[1] WANG Li;ZHOU Xue-yuan;JIANG Jie-si;WEN Ji(Reproductive Center of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001)

机构地区：[1]山东中医药大学第二附属医院生殖中心,济南250001

出　　处：《生殖医学杂志》2020年第9期1192-1197,共6页Journal of Reproductive Medicine

摘　　要：目的比较高孕激素促排卵(PPOS)方案在FSH升高的卵巢低反应(POR)患者促排卵治疗中的应用,寻求更适宜FSH升高的POR患者的促排卵治疗方案。方法选取2018年1月至2019年1月在我院生殖医学中心行IVF-ET的FSH≥10 U/L的POR患者210例为研究对象,按照随机数表法分为3组接受不同的促排卵方案:PPOS方案组(PPOS组,70例)、添加E2预处理的PPOS方案组(PPOS+E2组,70例)和微刺激方案组(微刺激组,70例)。比较各组患者的一般资料、Gn用药天数、Gn用量、HCG日LH、P、E2水平、≥14 mm卵泡数、卵泡输出率、受精率、优质胚胎率、周期取消率、冻融胚胎移植(FET)周期结局等。结果3组患者的一般资料比较均无显著性差异(P>0.05)。微刺激组Gn用药天数和Gn用量较PPOS组、PPOS+E2组显著减少(P<0.05)。微刺激组HCG日LH、E2水平、早发LH峰率较PPOS、PPOS+E2组显著升高(P<0.05)。3组间获卵数、2PN受精数、2PN卵裂数比较均无显著性差异(P>0.05);PPOS+E2组卵泡输出率显著高于PPOS组、微刺激组(P<0.05);PPOS、PPOS+E2组D3优胚率显著高于微刺激组(P<0.05);PPOS+E2组周期取消率显著低于PPOS组、微刺激组(P<0.05)。3组间FET周期的临床妊娠率、流产率、活产率比较均无显著性差异(P>0.05)。结论POR患者行IVF-ET使用PPOS方案,可以更好地控制LH峰,获得较好的优胚率;对于FSH升高的POR患者,PPOS+E2方案提高了卵泡输出率,能更好地控制早发LH峰,降低周期取消率,是该类患者行IVF-ET较为适宜的促排卵方案。Objective:To explore the application of progestin-primed ovarian stimulation(PPOS)protocol in patients with poor ovarian response(POR)and elevated FSH,and to find a more suitable treatment for ovulation induction in POR patients with elevated FSH.Methods:A total of 210 POR patients with FSH levels(≥10 U/L)in our reproductive center from January 2018 to January 2019 were randomly divided into three groups:PPOS scheme group(n=70),PPOS+E2 scheme group(n=70)and the mild ovarian stimulation scheme group(n=70).The basic characteristics,the duration of gonadotropin(Gn)administration,total dose of Gn,the levels of LH,progesterone,E2 on HCG days,number of follicle≥14 mm,follicle output rate,fertilization rate,high-quality embryo rate,cycle cancellation rate and FET outcome were compared among the three groups.Results:There was no significant difference in the basic characteristics among the three groups(P>0.05).The duration and total doses of Gn administration in the mild ovarian stimulation scheme group were significantly less than those in PPOS scheme group and PPOS+E2 scheme group(P<0.05).The levels of LH and E2 on HCG days and the premature LH surge rate in the mild ovarian stimulation scheme group were significantly higher than those in PPOS scheme group and PPOS+E2 scheme group(P<0.05).There was no significant difference in the number of oocytes,2PN fertilization rate and cleavage rate among the three groups(P>0.05).The follicle output rate of PPOS+E2 scheme group was significantly higher than that of PPOS scheme group and the mild ovarian stimulation scheme group(P<0.05).The high-quality embryo rate on Day 3 of PPOS scheme group and PPOS+E2 scheme group was significantly higher than that of the mild ovarian stimulation scheme group(P<0.05).The cycle cancellation rate of PPOS+E2 scheme group was significantly lower than that of PPOS scheme group and mild ovarian stimulation scheme group(P<0.05).There was no significant difference in the clinical pregnancy rate,abortion rate and live birth rate among the three gr

关 键 词：卵巢低反应 高FSH水平 高孕激素促排卵方案 雌激素 体外受精-胚胎移植 妊娠 

分 类 号：R711.6[医药卫生—妇产科学]