卵巢低反应波塞冬分类年轻患者促排卵方案的选择  

The ovulation-inducing treatments of young patients in POSEIDON groups

作　　者：周城 孙琴[1] 程茜 李鸿儒[1] 姚兵[1] 陈莉[1] ZHOU Cheng;SUN Qin;CHENG Xi;LI Hong-ru;YAO Bing;CHEN Li(Reproduction Medicine Center,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)生殖医学中心,南京210002

出　　处：《医学研究生学报》2020年第9期948-951,共4页Journal of Medical Postgraduates

基　　金：江苏省重点研发计划(BE2018714)。

摘　　要：目的辅助生殖促排卵过程中,对于卵巢低反应(POR)患者的处理是一大难点。文中探讨POR波塞冬分类年轻患者的最佳促排卵方案。方法回顾性分析2012年1月至2019年9月在东部战区总医院生殖医学中心收治的543例POR波塞冬分类1类和3类的年轻患者体外受精-胚胎移植周期,比较使用卵泡期长效长方案(长效长组)和黄体期短效长方案(短效长组)患者临床特征及妊娠结局差异。结果1类和3类患者长效长组的窦卵泡数(AFC)、抗苗勒氏管激素(AMH)均低于短效长组(P<0.05)。两类患者使用不同方案人群的不孕年限、BMI差异均无统计学意义(P>0.05)。两类患者的长效长组Gn天数、Gn使用量均高于短效长组(P<0.05),HCG日E2、获卵数均低于短效长组(P<0.05),HCG日孕酮(P)、内膜厚度、2PN数、优质胚胎数、移植胚胎数、未取到卵子率、无可移植胚胎率差异无统计学意义(P>0.05)。两类患者使用卵泡期长效长方案和使用黄体期短效长方案的胚胎种植率、临床妊娠率、流产率、多胎率差异均无统计学意义(P>0.05)。但两类患者长效长组的临床妊娠率数值更高。结论POR波塞冬分类的年轻患者在卵巢储备功能更差的基础状态下,使用卵泡期长效长方案仍是一个较理想的临床方案。Objective Poor ovarian response(POR)is a major difficulty in the process of assisted reproductive ovulation induction.This paper aims to explore the optimal ovulation induction protocol for young patients with POR in POSEIDON groups.Methods The clinical data of 543 young patients with poor ovarian response who were treated in the Reproductive Medicine Center of Central Hospital of Eastern Theater Command from January 2012 to September 2019 were retrospectively analyzed.The vitro fertilization-embryo transfer cycle of patients were Type 1 and Type 3 classified by POSEIDON criteria.They were divided into two groups:One group were treated with long-acting GnRHa long protocol in follicular phase,and another group were treated with short-acting GnRHa long protocol in mid-luteal phase.The clinical characteristics and pregnancy outcomes were compared.Results The AFC and AMH of short-acting GnRHa long protocol group were significantly lower than that of long-acting GnRHa long protocol group(P<0.05).There was no significant difference in the duration of infertility and BMI between the two group(P>0.05).The days and dosage of Gn were significantly higher in long-acting GnRHa long protocol group(P<0.05),and E2 levels and number of oocytes on the day of HCG injection were significantly lower in long-acting GnRHa long protocol group(P<0.05).There was no significant difference in Plevels,endometrial thickness,number of 2PN,number of good quality embryos,number of transferred embryos,proportion of non-oocyte re-trieved and proportion of non-transplantable embryos(P>0.05).There was no significant difference in implantation rate,clinical pregnant rate,abortion rate and multiple pregnancy rate in the two groups(P>0.05).But the absolute value of clinical pregnant rate of long-acting GnRHa long protocol group was higher than that of shortacting GnRHa long protocol group.Conclusion The long-acting GnRHa long protocol in follicular phase is still a good choice for young patients with poor ovarian response in POSEIDON groups with worse

关 键 词：卵巢低反应 波塞冬分类 促排卵方案 

分 类 号：R782.2[医药卫生—口腔医学]