卵巢储备正常人群拮抗剂方案促排卵添加来曲唑的应用  

Application of GnRH Antagonist and Letrozole Co-treatment in Normal Ovarian Reserve Patients

作　　者：李婷婷[1] 陈攀宇[1] 李砚青 王艳芳[1] 方丛[1] LI Tingting;CHEN Panyu;LI Yanqing(Reproductive Medicine Research Center,The Sixth Affiliated Hospital,Sun Yat-Sen University,Guangzhou Guangdong 510655,China)

机构地区：[1]中山大学附属第六医院生殖医学研究中心,广东广州510655

出　　处：《实用妇产科杂志》2021年第2期143-146,共4页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金(编号:81871214);国家重点研发计划“生殖健康及重大出生缺陷防控研究”重点专项课题(编号:2017YFC1001603)。

摘　　要：目的:探讨卵巢储备正常人群拮抗剂方案联合来曲唑促排卵的效果。方法:回顾性分析2015年1月至2019年10月于中山大学附属第六医院生殖医学研究中心行第1次或第2次促排卵周期,月经周期25~35天,年龄在22~38岁,抗苗勒管激素(AMH)1.1~3.6 ng/ml,促卵泡生成素(FSH)<10 U/L,窦卵泡数量(AFC)>6个,共867个周期,拮抗剂方案合并应用来曲唑共462个周期,为A组,常规拮抗剂促排卵不添加来曲唑共405个周期,为B组。比较两组之间的促排卵情况、胚胎资料以及妊娠结局。结果:两组患者一般资料总体服从正态性、方差齐性,年龄、体质量指数(BMI)、基础FSH、AMH差异无统计学意义(P>0.05),A组的Gn用量、获卵数明显比B组少,绒促性素(HCG)日雌激素更低,子宫内膜厚度更薄,但黄体生成素(LH)与对照组相比,相对较高,差异有统计学意义(P<0.05)。A组HCG日孕酮提前升高比例、LH峰早发率均比B组高,但卵子成熟率、2PN受精率、优质胚胎率、移植妊娠率均比B组要低,差异有统计学意义(P<0.05),A组的OHSS发生率明显更低(1.93%vs 4.44%)。结论:卵巢储备正常患者拮抗剂方案促排卵,合并使用来曲唑可能对移植妊娠率、卵子成熟和受精有不利影响,积极的是可降低Gn使用量以及降低OHSS发生机会。Objective:Toinvestigate the clinical value of letrozole during in vitro fertilization-embryo transfer(IVF-ET)for normal ovarian reserve patients who were treated with GnRH antagonist protocol.Methods:A retrospective study was conducted with clinic-based data in the Reproductive Medicine Centre of the Sixth Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Oct 2019.Patients who underwent first or second IVF-ET cycle,with age between 22-38 years old,AMH between 1.1-3.6 ng/ml,FSH<10 U/L,AFC>6,were involved.A total of 867 cycles were analyzed.All thecycles were divided into 2 groupsbased on whether letrozole was administrated.Cycles with letrozole administration was enrolled in group A(n=462);cycles without letrozole was selected as group B(n=405).We compared the ovulation induction,embryonic status and clinical outcomes of the 2 groups.Results:The general data of the two groups were subject to normality and homogeneity of variance.There were no significant differences in age,BMI,AMH or basal FSH between 2 groups(P>0.05).The dosage of GN and the number of oocytes retrieved in group A were significantly less than those in group B.The estrogen level on hCG day was lower and the thickness of endometrium was thinner in group A.However,compared with the control group,the luteinizing hormone(LH)was relatively higher,and the difference was statistically significant(P<0.05).The proportion of progesterone rising ahead of time on hCG day and the rate of premature LH peak in group A were higher than those in group B.However,the rate of oocyte maturation,2 PN fertilization,high-quality embryo rate and pregnancy transfer rate in group A were lower than those in group B,and the differences were statistically significant(P<0.05).But positive aspectwas that Group A had lower OHSS incidence rate(1.93%vs 4.44%).Conclusions:Combination of letrozole in antagonist protocol for patients with normal ovarian reserve may have adverse effects on pregnancy rate,oocyte maturation and fertilization.Positive effects are to reduce Gn

关 键 词：体外受精-胚胎移植 来曲唑 拮抗剂 卵巢储备正常 卵巢过度刺激综合征 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]