短效口服避孕药在40岁以上高FSH患者IVF/ICSI中的短时应用分析  

Effects of short-acting oral contraceptives during IVF/ICSI in infertile women over 40 years old with high FSH level

作　　者：蒋春艳[1] 鲁南 张园[1] 袁纯[1] 钱易[1] 王菁[1] 刁飞扬[1] 马翔[1] 刘金勇[1] 刘嘉茵[1] 高彦[1] JIANG Chun-yan;LU Nan;ZHANG Yuan;YUAN Chun;QIAN Yi;WANG Jing;DIAO Fei-yang;MA Xiang;LIU Jin-yong;LIU Jia-yin;GAO Yan(Reproductive Medicine Center,the First Affiliated Hospital of 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中心,南京210029

出　　处：《生殖医学杂志》2022年第4期435-440,共6页Journal of Reproductive Medicine

基　　金：江苏省高校优势学科建设工程(JX10231802);国家自然科学基金(81501225);江苏省自然科学基金(BK20151030);江苏省卫健委项目(M2020097)。

摘　　要：目的探讨避孕药短时应用结合微刺激方案在40岁以上高FSH患者体外受精-胚胎移植中的促排卵效果及周期结局。方法回顾性分析2016年1月至2020年10月在南京医科大学第一附属医院生殖中心行克罗米芬联合HMG微刺激IVF或ICSI助孕的40岁以上患者的临床资料,共227个周期。其中,基础FSH≥20 U/L者予口服避孕药(OCP)短时预处理,为OCP组(n=103);而10 U/L<FSH<20 U/L者直接予微刺激IVF,为非OCP组(n=124)。比较两组患者间临床促排卵指标及周期结局。结果OCP组患者的窦卵泡计数(AFC)、抗苗勒管激素(AMH)水平显著低于非OCP组(P<0.001)。OCP组预处理前基础FSH水平、LH水平显著高于非OCP组,而雌激素水平显著低于非OCP组(P<0.001);经过OCP处理后,OCP组FSH水平显著低于非OCP组(P<0.001)。微刺激方案促排卵中,与非OCP组比较,OCP组Gn用量更多(P<0.001),扳机日内膜厚度更薄(P<0.05),获卵数、2PN胚胎数和优质胚胎数更少(P<0.05),而总周期取消率更高(P<0.001)。两组间每取卵周期的临床妊娠率、流产率、活产率均无显著差异(P>0.05)。结论对40岁以上高龄FSH>20 U/L无法常规启动IVF促排卵的患者,可行OCP短时预处理,可有效降低FSH和LH水平,结合微刺激方案能有效帮助部分患者获得妊娠。Objective:To investigate the effect and outcome of short-term application of contraceptives combined with micro stimulation protocol during IVF-ET in patients over 40 years old with high FSH.Methods:The clinical data of patients(227 cycles)aged>40 years who underwent IVF/ICSI with clomiphene and micro stimulation protocol in of Reproductive Medicine Center,the First Affiliated Hospital of Nanjing Medical University from January 2016 to October 2020 were retrospectively analyzed.Among them,the patients with basal FSH≥20 U/L had short-term pretreatment with oral contraceptive(OCP)as OCP group(n=103),and the patients with 10 U/L<FSH<20 U/L were directly given micro stimulation in IVF as non-OCP group(n=124).Relevant indicators during the ovarian stimulation and cycles outcomes were compared between the two groups.Results:The levels of antral follicle count(AFC)and anti-Mullerian hormone(AMH)in OCP group were significantly lower than those in non-OCP group(P<0.001).The basal levels of FSH and LH in OCP group were significantly higher,but estrogen level was significantly lower than that in non-OCP group(P<0.001).After OCP pretreatment,the FSH level in OCP group was significantly lower than that in non-OCP group(P<0.001).In the micro induction ovulation protocol,the dosage of Gn used was significantly more(P<0.001),endometrial thickness on the trigger day was significantly thinner(P<0.05),the numbers of oocytes retrieved,2PN embryos and high-quality embryos were significantly less(P<0.05),but the total cycle cancellation rate was significantly higher in the OCP group compared with the non-OCP group(P<0.001).There were no significant differences in clinical pregnancy rate,abortion rate and live birth rate between the two groups(P>0.05).Conclusions:For patients over 40 years old with FSH>20 U/L who are unable to initiate induction ovulation for IVF,OCP short-term pretreatment can effectively reduce their FSH and LH levels.Combined with micro stimulation protocol,it can effectively help some patients to obtain pregnancy

关 键 词：口服避孕药 不孕 诱导排卵 生育高龄 体外受精-胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学]