波塞冬分类标准下的不同卵巢刺激方案对卵巢低反应患者的疗效分析  

Comparison of different ovarian hyperstimulation protocols efficacy in poor ovarian responders classified by Poseidon criteria

作　　者：李飞[1] 牛爱琴[1] 冯建兵 王晨晨 冯兴梅[1] 张亚莉[1] 陈莹 Li Fei;Niu Aiqin;Feng Jianbing;Wang Chenchen;Feng Xingmei;Zhang Yali;Chen Ying(Center for Reproductive Medicine,the First People's Hospital of Shangqiu,Shangqiu 470000,China;Reproductive Medicine Center,the First Clinical College of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]商丘市第一人民医院生殖医学中心,470000 [2]郑州大学第一临床学院生殖医学中心,450000

出　　处：《中华生殖与避孕杂志》2021年第9期770-775,共6页Chinese Journal of Reproduction and Contraception

基　　金：河南省科技攻关项目(212102310049);河南省部联合共建项目(LHGJ20200933);河南省研究生科研创新项目(HNGRI2018091)。

摘　　要：目的探讨基于波塞冬分类标准下的卵泡期长效长方案、黄体期短效长方案和拮抗剂方案在卵巢低反应人群中的治疗效果,为卵巢低反应患者提供合适的治疗方案。方法回顾性队列研究分析2013年3月至2018年12月期间在郑州大学第一临床学院生殖医学中心行体外受精(in vitro fertilization,IVF)/卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)治疗的,且根据波塞冬分类标准筛选卵巢低反应预期患者的临床资料,按年龄因素分为低年龄组(<35岁组)和高年龄组(≥35岁组),进行不同治疗方案的临床疗效对比。结果本研究共纳入患者1249例,其中低年龄组410例,高年龄组839例。在低年龄组中,卵泡期长效长方案相对比于黄体期短效长方案和拮抗剂方案,可获得更多的卵母细胞数[(5.6±3.6)枚比(4.6±3.2)枚比(2.4±1.7)枚,P<0.001]和可移植胚胎数[(2.2±1.6)枚比(1.6±1.6)枚比(1.1±1.1)枚,P<0.001],更低的移植周期取消率[20.8%(33/159)比39.5%(49/124)比69.3%(88/127),P<0.001],更高的妊娠率[40.9%(65/159)比29.0%(36/124)比15.7%(20/127),P<0.001]和活产率[31.4%(50/159)比23.4%(29/124)比12.6%(16/127),P<0.001],三种治疗方案的种植率和流产率差异均无统计学意义(P>0.05)。在高年龄组中,卵泡期长效长方案相对比于黄体期短效长方案和拮抗剂方案,可获得更多的卵母细胞数[(3.9±2.8)枚比(3.1±2.3)枚比(2.5±1.8)枚,P<0.001]和可移植胚胎数[(2.8±2.0)枚比(2.4±2.0)枚比(2.1±1.7)枚,P<0.001],但三种治疗方案在种植率、妊娠率、流产率和活产率方面差异均无统计学意义(P>0.05)。结论对于预期卵巢低反应的年轻患者,卵泡期长效长方案比黄体期短效长方案和拮抗剂方案拥有更好的临床结局。值得强调的是年龄越大,妊娠结局越差,另外应根据卵巢低反应患者的特点和个体差异针对性制定治疗方案。Objective To compare the efficiency of the early-follicular phase long-acting gonadotropin-releasing hormone agonist(GnRH-a)long protocol,the mid-luteal phase short-acting GnRH-a long protocol and the gonadotropin-releasing hormone antagonist(GnRH-A)protocol in poor ovarian responders classified by Poseidon criteria,and to explore the most appropriate and effective ovarian hyperstimulation protocol in each Poseidon criteria.Methods The clinical data from poor ovarian responders according to the Poseidon criteria who underwent in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)in the Reproductive Medicine Center of the First Clinical College of Zhengzhou University were retrospectively analyzed by a cohort study.The patients were further divided into lower age group(<35 years)and high age group(≥35 years).The data of baseline characteristics and clinical outcomes in each ovarian hyperstimulation protocol group were analyzed and compared.Results Totally 1249 eligible subjects were recruited in the study,including 410 patients in lower age group and 839 patients in high age group.In lower age group,early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number(5.6±3.6 vs.4.6±3.2 vs.2.4±1.7,P<0.001)and No.of transferable embryos(2.2±1.6 vs.1.6±1.6 vs.1.1±1.1,P<0.001),lower cancellation rate of embryo transfer[20.8%(33/159)vs.39.5%(49/124)vs.69.3%(88/127),P<0.001],higher pregnancy rate per transfer[40.9%(65/159)vs.29.0%(36/124)vs.15.7%(20/127),P<0.001],and higher live birth rate[31.4%(50/159)vs.23.4%(29/124)vs.12.6%(16/127),P<0.001]than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol.However,there was no significant difference in implantation rate and abortion rate among three protocols(P>0.05).In high age group,the early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number(3.9±2.8 vs.3.1±2.3 vs.2.5±1.8,P<0.001)and No.of transferable embryos(2.8±2.0 vs.2.4±2.0 vs.2.1±1.7,P<0.001),lower cancellati

关 键 词：波塞冬标准 卵巢低反应 控制性卵巢刺激方案 受精 体外 活产 

分 类 号：R714.8[医药卫生—妇产科学]