卵巢/输卵管手术后合并卵巢功能减退患者自然周期/微刺激方案IVF/ICSI-ET助孕结局分析  

Analysis of pregnancy outcome of IVF/ICSI-ET with natural cycle or micro-stimulation protocol in patients with diminished ovarian reserve(DOR)after ovarian/fallopian tube surgery

作　　者：袁纯[1] 蒋春艳[1] 王菁[1] 刁飞扬[1] 马翔[1] 刘嘉茵[1] 高彦[1] YUAN Chun;JIANG Chun-yan;WANG Jing;DIAO Fei-yang;MA Xiang;LIU Jia-yin;GAO Yan(Clinical Center of Reproductive Medicine,First Af liated Hospital,Nanjing Medical University,Nanjing 210029)

机构地区：[1]南京医科大学第一附属医院生殖医学科,南京210029

出　　处：《生殖医学杂志》2021年第9期1135-1140,共6页Journal of Reproductive Medicine

基　　金：生殖医学国家重点实验室开放基金课题(SKLRM-K201805);江苏省自然科学青年基金(BK20191076);国家自然科学青年基金(81901449)。

摘　　要：目的探讨卵巢/输卵管手术后合并卵巢功能减退(DOR)患者行自然周期/微刺激方案IVF/ICSI-ET助孕的临床结局。方法本研究纳入了2015年1月至2018年12月在本中心接受自然周期/微刺激方案IVF/ICSI-ET助孕治疗的DOR患者,共7862个周期。根据既往病史分为卵巢/输卵管手术组(A组)和未手术组(B组)两组,统计两组患者一般资料、促排卵及胚胎移植结局;并将A组患者根据手术类型进一步分为卵巢手术组(A1组)、输卵管手术组(A2组)及卵巢+输卵管手术组(A3组),比较3组间的助孕结局。结果(1)B组患者年龄显著高于A组[(42.34±0.09)vs.(40.33±0.04)岁,P=0.000],而两组间抗苗勒管激素(AMH)水平、基础FSH水平及体质量指数(BMI)均无统计学差异(P>0.05);两组间每周期获卵数、受精数、可移植胚胎数、未获可移植胚胎率均无统计学差异(P>0.05);两组间鲜胚移植妊娠结局(HCG阳性率、临床妊娠率、活产率)均无统计学差异(P>0.05),但A组冻融胚胎移植(FET)周期活产率显著升高(17.38%vs.13.62%,P=0.033)。(2)手术史分类比较:A1、A2、A3组间年龄、BMI均无统计学差异(P>0.05),但A1组的基础FSH水平较其他两组显著升高(P<0.05);鲜胚移植周期结局分析中,A1组活产率较A2组显著降低(4.34%vs.9.33%,P=0.007),而3组间FET周期的临床结局无统计学差异(P>0.05)。结论卵巢/输卵管手术虽然对卵巢储备功能以及在微刺激/自然周期IVF/ICSI-ET的药物反应性影响较大,但并未显著影响其IVF/ICSI-ET的最终结局;年龄因素与妊娠结局密切相关,手术诱发卵巢功能减退的年轻患者接受微刺激/自然周期方案的IVF-ET助孕结局较好。Objective:To analyze the clinical outcome of IVF/ICSI-ET with natural cycle or micro-stimulation protocol in patients with diminished ovarian reserve(DOR)after ovarian/fallopian tube surgery.Methods:This study included 7862 IVF/ICSI-ET cycles with natural cycle or micro-stimulation protocol in our hospital from Jan.2015 to Dec.2018.According to surgery history,the cycles were divided into two group:ovary/oviduct surgery group(group A)and non-surgery group(group B),and the general information,ovulation induction and embryo transfer outcomes of the two groups were compared.The cycles in group A was subdivided into ovary surgery group(group A1).oviduct surgery group(group A2)and ovary and oviduct surgery group(group A3).The clinical data and pregnancy outcomes of patients was compared among three groups.Results:(1)The age of patients in group B was significantly older than that of group A[(42.34±0.09)vs.(40.33±0.04),P=0.000],but the AMH level,basic FSH level and BMI had no significant difference(P>0.05).There were no significant differences in the number of oocytes retrieved,fertilized embryos and embryos transplantable,no-embryo transplantable rate between the group A and B(P>0.05).There was no significant difference in pregnancy outcome(HCG positive rate,clinical pregnancy rate and live birth rate)between the two groups(P>0.05),but the live birth rate of frozen-thawed embryo transfer(FET)cycle in group A was significantly increased(17.38%vs.13.62%,P=0.033).(2)There were no significant differences in age and BMI among the group A1,A2 and A3,but the basal FSH level of group A1 was significantly higher than that in the other two groups(P<0.05).In fresh embryo transfer cycles,the live birth rate in group A1 significantly lower than that of group A2(4.34%vs.9.33%,P=0.007),but there was no significant difference in the pregnancy outcomes in frozen embryo cycles(P>0.05).Conclusions:Although ovarian/fallopian tube surgery has a great impact on ovarian reserve function and drug response in micro-stimulation/natural cycle

关 键 词：卵巢功能减退 微刺激 自然周期 体外受精-胚胎移植 手术损伤 

分 类 号：R711.74[医药卫生—妇产科学] R711.6[医药卫生—临床医学]