PPOS方案联合生长激素对卵巢低储备患者体外受精助孕的影响  

The outcome of diminished ovarian reserve patients following progestin primed ovarian stimulation protocol co-treatment with growth hormone

作　　者：王慧 薛雪[1] 徐礼荣 马会兰 吕颖[2] 张雁冰[2] 孙丽华 WANG Hui;XUE Xue;XU Li-rong;MA Hui-lan;LU Ying;ZHANG Yan-bing;SUN Li-hua(Dept.of Assisted Reproduction,Shanghai East Hospital,School of Medicine,Tongji University,Shanghai 200120,China;Dept.of VIP,Shanghai East Hospital,School of Medicine,Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院生殖医学中心,上海200120 [2]同济大学附属东方医院特诊部,上海200120

出　　处：《同济大学学报（医学版）》2021年第5期627-632,共6页Journal of Tongji University(Medical Science)

基　　金：上海市科学技术委员会基金(18411964000)。

摘　　要：目的探讨在卵巢低储备(diminished ovarian reserve,DOR)患者中运用高孕激素状态下促排卵(progestin primed ovarian stimulation,PPOS)方案促排卵时,添加生长激素(growth hormone,GH)是否可以增加卵泡的募集、提高优质胚胎数量以及在哪个年龄阶段可以获益。方法回顾性分析228例应用PPOS方案联合GH控制性超促排卵的DOR患者用药前和用药后的临床资料,按控制性超促排卵过程中是否运用GH及运用GH的促排卵周期数,将患者分成三组,即A组(对照组,228例,未添加GH)、B组(治疗组,228例,第1次添加GH)和C组(治疗组,103例,连续两次添加GH);再根据患者年龄,按5岁为一个年龄段,将所有入组患者分为5组;分别比较相同年龄段对照组和治疗组基础窦卵泡数、HCG日卵泡数、获卵数及优质胚胎数的差异。结果第1次添加GH促排卵周期,40~44岁年龄组患者中,B组HCG日卵泡数、获卵数及优质胚胎数均较A组高(P=0.02、0.004、0.00、0.01);连续2个促排卵周期均添加GH后,40~44岁年龄组患者中,C组基础窦卵泡数、HCG日卵泡数及优质胚胎数均较A组高(P=0.008、0.01、0.045),获卵数差异无统计学意义(P>0.05)。<30岁、30~34岁年龄组患者中,第1周期添加GH和连续2个促排卵周期均添加GH,B组、C组与A组基础窦卵泡数、HCG日卵泡数及获卵数差异均无统计学意义(P>0.05),B组、C组优质胚胎数均较A组高(P=0.03、0.045、0.02、0.01)。35~39岁及>45岁年龄组添加GH治疗后基础窦卵泡数、HCG日卵泡数、获卵数及优质胚胎数与用药前差异无统计学意义(P>0.05)。结论在PPOS方案控制性超促排卵时,添加GH可以增加40~44岁年龄阶段卵巢低储备患者基础窦卵泡的募集及提高胚胎质量。对于其他年龄阶段运用PPOS方案促排卵的卵巢低储备患者的窦卵泡募集无明显效果,但可以增加<30岁及30~34岁患者优质数量。Objective To analyze the outcome of progestin primed ovarian stimulation(PPOS)protocol adding growth hormone during ovulation induction in diminished ovarian reserve(DOR)patients.Methods The clinical data of DOR patients who received PPOS protocol were analyzed retrospectively.Patients were divided into three groups:group A(control group,228 cases,no GH added),group B(treatment group,228 cases,first time addition of GH in ovulation cycle)and group C(treatment group,103 cases,GH added successively in ovulation cycle).The numbers of antral follicles,follicles in HCG day,eggs obtained and good-quality embryos was compared among groups in the same age group.Results For patients age in age group 40 to 44,the numbers of follicles on HCG day,eggs obtained and good-quality embryos in group B were significantly higher than those in group A(P=0.02,0.004,0.00,0.01);the numbers of antral follicles,follicles on HCG day and good-quality embryos in group C were significantly higher than those in group A(P=0.008,0.01,0.045).For patients age below 35 years,the numbers of antral follicles,follicles on HCG day and eggs obtained in group B and group C had no significant difference with those in group A,however,the number of good-quality embryos in group B and group C were higher than those in group A(P=0.03,0.045,0.02,0.01).For patients in age group of 35 to 39,there was no significant difference between control group and treatment groups in the number of antral follicles,follicles on HCG day,eggs obtained and good-quality embryos.Conclusion When using PPOS protocol with GH,the numbers of antral follicle recruitment and good-quality embryos in 40-44 years age group are increased.Adding GH can also increase the number of good-quality embryos in patients of<34 age group,but there is no benefit for other age groups.

关 键 词：生长激素 卵巢低储备 PPOS方案 卵泡募集 优质胚胎 

分 类 号：R717[医药卫生—妇产科学]