高剂量来曲唑在卵巢低反应患者微刺激方案中的临床观察  

The use of high-dose Letrozole in poor ovarian response patients receiving mild ovarian stimulation

作　　者：侯艳茹[1] 贾莹莹 王艳槟[1] 沈浣[1] 韩红敬[1] HOU Yanru;JIA Yingying;WANG Yanbin;SHEN Huan;HAN Hongjing(Reproductive Center,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院生殖医学中心,100044

出　　处：《中国妇产科临床杂志》2022年第2期146-149,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：北京大学人民医院与中国科学院动物研究所合作项目(2019-Q-01)。

摘　　要：目的探讨高剂量来曲唑在卵巢低反应(POR)患者微刺激方案中的临床应用价值。方法回顾性分析2016年1月至2018年12月在本院生殖中心就诊的102例行来曲唑微刺激方案体外受精/卵胞浆内单精子注射(IVF/ICSI)治疗的POR患者。其中接受高剂量来曲唑(7.5 mg/d×5 d)为高剂量组(n=50),接受常规剂量来曲唑(5 mg/d×5 d)为常规剂量组(n=52)。结果高剂量组年龄和基础FSH均高于常规剂量组(P<0.05),高剂量组窦卵泡数(AFC)明显低于常规剂量组(P<0.05)。高剂量组促性腺激素(Gn)使用时间短于常规剂量组(P<0.05),人绒毛膜促性腺激素(hCG)日血清E;水平显著降低(P<0.05),获卵数低于常规剂量组,但卵子MⅡ率明显高于常规剂量组(P<0.05)。高剂量组每新鲜移植周期临床妊娠率(55.56%,50%)和活产率(55.56%,37.5%)有所增加,与常规剂量组比较,差异无统计学意义(P>0.05)。结论添加高剂量来曲唑的微刺激方案对于POR患者的临床妊娠结局有一定的改善,无明显不良反应,尤其对于卵巢储备更差的POR患者,可能通过改善卵母细胞质量,MⅡ率高提示卵泡质量有改善,使这部分患者从中获益。Objective To explore the clinical application value of high-dose letrozole in poor ovarian response(POR)patients during mild ovarian stimulation protocols receiving IVF/ICSI.Methods A retrospective analysis was performed on 102 patients with POR treated with letrozole mild ovarian stimulation in IVF/ICSI at our reproductive Center from January 2016 to December 2018.The high-dose letrozole group(7.5 mg/d×5 d)was the high-dose group(n=50),and the conventional letrozole group(5 mg/d×5 d)was the conventional dose group(n=52).Results The age and basal FSH of the high-dose group were higher than those of the conventional dose group(P<0.05),and the number of sinus follicles(AFC)in the high-dose group was significantly lower than that in the conventional dose group(P<0.05).The time of use of gonadotropin(Gn)in high dose group was shorter than that in conventional dose group(P<0.05),the daily serum E2 level of human chorionic gonadotropin(hCG)was significantly decreased(P<0.05),the egg number was lower than that in conventional dose group,but the egg MⅡrate was significantly higher than that in conventional dose group(P<0.05).The clinical pregnancy rate and live birth rate per fresh transplant cycle increased in the high-dose group[55.56%vs 50%;55.56%vs 37.5%],but the difference was not statistically significant compared with the conventional dose group(P>0.05).Conclusion For POR patients receiving ART,high-dose letrozole with mild ovarian stimulation protocol can improve the clinical pregnancy outcome of POR patients to some extent without obvious adverse reactions,especially for POR patients with poor ovarian reserve,which may benefit from improving oocyte quality and high MII rate suggesting improved follicle quality.

关 键 词：卵巢低反应 微刺激 来曲唑 超促排卵 

分 类 号：R714.8[医药卫生—妇产科学]