高孕激素状态促排卵与拮抗剂方案在卵巢储备功能减退的年轻人群中体外受精-胚胎移植结局比较  

Comparison of In Vitro Fertilization-Embryo transfer outcomes between progestin primed ovarian stimulation and GnRH antagonist regimens in young people with diminished ovarian reserve

作　　者：杨松青 周黎明[2] 王丽萍[3] 姚秋萍[3] 金敏[1] YANG Songqing;ZHOU Liming;WANG Liping;YAO Qiuping;JIN Min(Reproductive Center,the Second Affiliated Hospital of Zhejiang University School of Medicine,Zhejiang,Hangzhou 310009,China;Reproductive Center,Ningbo Women and Children's Hospital,Zhejiang,Ningbo 315000,China;Reproductive Center,Jiaxing Maternity and Child Health Care Hospital,Zhejiang,Jiaxing 314051,China)

机构地区：[1]浙江大学医学院附属第二医院生殖中心,浙江杭州310009 [2]浙江省宁波市妇女儿童医院生殖中心,浙江宁波315000 [3]浙江省嘉兴市妇幼保健院生殖中心,浙江嘉兴314051

出　　处：《中国医药科学》2021年第1期8-12,共5页China Medicine And Pharmacy

基　　金：国家自然科学基金(81671487)。

摘　　要：目的比较卵巢储备功能减退(DOR)的年轻患者中高孕激素状态促排卵(PPOS)和促性腺激素释放激素拮抗剂促排卵(Gn RH-ant)方案的体外受精-胚胎移植结局。方法回顾性分析2013年3月至2017年12月在浙江大学医学院附属第二医院、嘉兴市妇幼保健院和宁波市妇女儿童医院生殖中心进行体外受精的284例年轻DOR患者的相关数据。按抗苗勒管激素(AMH)水平及促排卵方案分为A组:0.1 ng/ml<AMH≤0.5 ng/ml,PPOS方案;B组:0.1 ng/ml<AMH≤0.5 ng/ml,Gn RH-ant方案;C组:0.5 ng/ml<AMH≤1.1 ng/ml,PPOS方案;D组:0.5 ng/ml<AMH≤1.1 ng/ml,Gn RH-ant方案。结果与B组比较,A组窦卵泡数、获卵数、MⅡ卵子数、Gn用量较少,扳机日[即注射外源性绒毛膜促性腺激素(HCG)日]黄体生成素(LH)水平较高(P<0.05),两组的HCG日雌二醇(E2)水平、MⅡ率、可利用卵裂期胚胎率、囊胚形成率、可利用胚胎率、周期取消率及妊娠结局差异均无统计学意义。与D组比较,C组Gn用量较少,HCG日LH水平较高(P<0.05),其余指标差异均无统计学意义。获卵数多元线性回归、临床妊娠广义估计方程均表明两方案无明显区别。结论在0.1 ng/ml<AMH≤1.1 ng/ml年轻DOR患者人群中,PPOS方案与Gn RH-ant方案促排卵疗效相当。Objective To compare the In Vitro Fertilization-Embryo transfer outcomes between progestin primed ovarian stimulation(PPOS)and gonadotropin-releasing hormone antagonist(GnRH-ant)regimens in young patients with diminished ovarian reserve(DOR).Methods The related data of 284 young patients with DOR in the Second Affiliated Hospital of Zhejiang University School of Medicine,Ningbo Women and Children’s Hospital and Jiaxing Maternity and Child Health Care Hospital from March 2013 to December 2017 were retrospectively analyzed.According to anti-mullerian hormone(AMH)level and ovarian stimulation regimen,they were divided into group A(with 0.1 ng/ml<AMH≤0.5 ng/ml and PPOS regimen),group B(with 0.1 ng/ml<AMH≤0.5 ng/ml and GnRH-ant regimen),group C(with 0.5 ng/ml<AMH≤1.1 ng/ml and PPOS regimen)and group D(with 0.5 ng/ml<AMH≤1.1 ng/ml and GnRH-ant regimen).Results Compared with group B,the antral follicle number,retrieved oocyte number,MⅡoocyte number and Gn dosage in group A were less,and the luteinizing hormone(LH)level on human chorionic gonadotropin(HCG)day was higher(P<0.05).Meanwhile,there were no statistically significant differences in the estradiol(E2)level on HCG day,MⅡrate,available cleavage embryo rate,blastocyst formation rate,available embryo rate,cycle cancellation rate and pregnant outcomes of the two groups.Compared with group D,the Gn dosage in group C was less,and the LH level on HCG day was higher(P<0.05),and there were no statistically significant differences in other indexes.Multiple linear regression of retrieved oocyte number and generalized estimating equation of clinical pregnancy both showed that there was no obvious difference between the two regimens.Conclusion In young patients with DOR with 0.1 ng/ml<AMH≤1.1 ng/ml,the PPOS regimen and GnRH-ant regimen have the same ovarian stimulation efficacy.

关 键 词：卵巢储备功能减退 体外受精-胚胎移植 PPOS方案 拮抗剂方案 

分 类 号：R711.75[医药卫生—妇产科学] R711.6[医药卫生—临床医学]