高孕激素促排卵与克罗米芬微刺激方案在卵巢低储备患者取卵周期的可控性比较  

Controllability comparison between progestin-primed ovarian stimulation and mild stimulation protocols in patients with diminished ovarian reserve in oocytes retrieval cycle

作　　者：FAN Xing-yan 于莎[1] 汪云[1] 匡延平[1] FAN Xing-yan;Y Sha;WANG Yun;KUANG Yan-ping(Department of Assisted Reproduction,Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院辅助生殖科,上海200011

出　　处：《中国临床医学》2021年第4期539-543,共5页Chinese Journal of Clinical Medicine

基　　金：国家重点研发计划(2018YFC1003000).

摘　　要：目的:比较卵巢低储备患者在取卵周期采用高孕激素促排卵(progestin-primed ovarian stimulation,PPOS)方案与克罗米芬微刺激促排卵方案的临床疗效及周期可控性。方法:回顾性分析因卵巢低储备接受体外受精-胚胎移植的患者,分为PPOS方案组(试验组)和克罗米芬微刺激方案组(对照组)。观察两组患者促排卵过程的早发促黄体生成素(LH)峰比例、促排卵药物的用量及用药时间、获卵数(率)、成熟卵数(率)及胚胎实验室结局等指标。结果:共纳入972例,每组486例。试验组中早发LH峰比例明显低于对照组(6.17%vs 39.92%,P<0.001)。两组患者获卵数(率)、成熟卵数、正常受精数(率)、卵裂数及有效胚胎数等指标差异均无统计学意义。试验组患者促排卵用药天数和用药量显著多于对照组,差异有统计学意义(P<0.001)。结论:PPOS方案能有效抑制早发LH峰的出现,是一种适合卵巢低储备患者的促排卵方案。Objective:To compare the clinical outcomes of progestin-primed ovarian stimulation(PPOS)with mild stimulation protocol in patients with diminished ovarian reserve.Methods:The patients with diminished ovarian reserve received in vitro fertilization-embryo transfer were retrospectively analyzed and divided into two groups:PPOS group(experimental group,n=486)and clomiphene citrate mild stimulation group(control group,n=486).Then,we analyzed the rate of premature luteinizing hormone surge,dose and duration of gonadotropin,retrieved oocyte number(rate),mature oocyte number(rate),fertilization oocytes number(rate),the number of viable embryos,etc,were analyzed.Results:There were 972 patients included,with 486 patients in each group.The premature luteinizing hormone surge rate in PPOS protocol was significantly lower than that in the mild stimulation group(6.17%vs 39.92%,P<0.001).There were no significant differences in retrieved oocytes number(rate),mature oocyte number,and some embryological characteristics between the two groups.The duration and dose of gonadotropin in the PPOS group were significantly greater than those in the mild stimulation group(P<0.001).Conclusions:Compared with mild stimulation protocol,the PPOS protocol can effectively inhibit the premature luteinizing hormone surge in diminished ovarian reserve patients.Therefore,PPOS protocol can offer an option for diminished ovarian reserve patients who received in vitro fertilization-embryo transfer.

关 键 词：卵巢低储备 高孕激素促排卵 克罗米芬微刺激 早发促黄体生成素峰 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]