不同控制性卵巢刺激方案对早发性卵巢功能不全患者获卵数和可用胚胎数的影响  

Effects of different control ovarian stimulation protocol on oocytes retrieved and available embryos in patients with premature ovarian insufficiency

作　　者：杨弘睚 马媛 石永乾 常振华 王茜怡 刘芳 王晓红 YANG Hong-ya;MA Yuan;SHI Yong-qian;CHANG Zhen-hua;WANG Qian-yi;LIU Fang;WANG Xiao-hong(Reproductive Medicine Center,Department of Obstetrics&Gynecology,Tangdu Hospital,Air Force Military Medical University,Xi’an 710038)

机构地区：[1]空军军医大学唐都医院妇产科生殖医学中心,西安710038

出　　处：《生殖医学杂志》2020年第10期1280-1286,共7页Journal of Reproductive Medicine

基　　金：唐都医院科里创新发展基金(2017LCYJ018)。

摘　　要：目的探讨不同控制性卵巢刺激(COS)方案对早发性卵巢功能不全(POI)患者获卵数和可用胚胎数的影响。方法回顾性分析2016年1月至2019年3月在我中心行IVF-ET治疗的184例POI患者,共行431个取卵周期。根据COS方案不同分为拮抗剂方案(n=121)、自然周期(n=55)、克罗米芬(CC)+促性腺激素(Gn)方案(n=149)、口服避孕药(OC)+Gn方案(n=60)、长方案(n=22)、超短方案(n=24)。采用广义估计方程(generalized estimating equation,GEE)分析的方法,探讨不同COS方案对POI患者获卵数和可用胚胎数的影响。结果对各组基线资料进行比较,不同COS方案周期患者间的夫妻双方年龄、BMI、基础FSH水平均无统计学差异(P>0.05);各组间基础窦卵泡数和AMH水平比较差异具有统计学意义(P<0.05)。拮抗剂方案、自然周期、CC+Gn方案、OC+Gn方案、长方案、超短方案的获卵数分别为(2.69±1.78)、(0.89±0.46)、(1.42±1.13)、(1.65±1.62)、(3.32±2.10)和(1.92±1.44)个,可用胚胎数分别为(1.24±1.15)、(0.44±0.54)、(0.55±0.74)、(0.72±0.90)、(1.55±1.63)和(0.96±1.08)个,可用胚胎率分别为(0.62±0.44)%、(0.45±0.50)%、(0.43±0.48)%、(0.43±0.46)%、(0.60±0.42)%和(0.54±0.49)%,组间差异均具有统计学意义(P<0.05)。进一步行多因素分析,自然周期、CC+Gn周期和OC+Gn周期的获卵数、MⅡ卵数及可用胚胎数显著少于拮抗剂方案(P<0.05)。结论对于POI患者,拮抗剂方案、长方案和超短方案可以获得相近的可用胚胎数,其中拮抗剂方案是第一选择方案,建议临床推广。对于自然周期、CC+Gn方案、OC+Gn方案在POI患者中的应用,仍然需要进一步探索。Objective:To explore the outcomes of different control ovarian stimulation(COS)protocols in patients with premature ovarian insufficiency(POI).Methods:A retrospective analysis was performed on 184 POI patients treated by IVF-ET in our center from January 2016 to March 2019,with a total of 431 oocytes retrieval cycles.According to the different COS protocols,the patients were divided into antagonist protocol(n=121),natural cycle protocol(n=55),clomiphene(CC)+gonadotropin(Gn)protocol(n=149),oral contraceptive protocol(OC)+Gn protocol(n=60),long protocol(n=22),ultra-short protocol(n=24).The influence of different COS protocols on the number of oocytes retrieval and available embryos in POI patients was investigated by generalized estimation equation(GEE).Results:The baseline data of each group were compared.There was no significant difference in age,BMI and basal FSH level among the patients with different COS protocols(P>0.05).However,the number of basal antral follicles and AMH level were significantly different among the groups(P<0.05).The number of oocytes retrieval in antagonist protocol,natural cycle protocol,clomiphene plus Gn protocol,OC+Gn protocol,long protocol,ultra-short protocol was(2.69±1.78)、(0.89±0.46),(1.42±1.13),(1.65±1.62),(3.32±2.10)and(1.92±1.44)respectively;the number of available embryos was(1.24±1.15),(0.44±0.54),(0.55±0.74),(0.72±0.90),(1.55±1.63)and(0.96±1.08),respectively;and the available embryo rate was(0.62±0.44)%,(0.45±0.50)%,(0.43±0.48)%,(0.43±0.46)%,(0.60±0.42)%,(0.54±0.49)%respectively,with significant differences(P<0.05).Further multi-factor analysis showed that the number of oocytes retrieved,the number of MⅡoocytes and the number of available embryos in the natural cycle protocol,CC+Gn protocol and OC+Gn protocol were significantly less than that of the antagonist protocol(P<0.05).Conclusions:For patients with POI,the antagonist protocol,long protocol and ultra-short protocol can obtain a similar number of available embryos,of which the antagonist protocol i

关 键 词：早发性卵巢功能不全 促排卵方案 获卵数 胚胎数 

分 类 号：R711.6[医药卫生—妇产科学]