高龄卵巢低储备人群不同促排卵方案的临床评价  

Comparison of different controlled ovarian hyperstimulation protocols in patients in advanced age with diminished ovarian reserve

作　　者：简生燕[1] 熊正方[1] 马荣花[1] 曾湘晖[1] 王睿 李斌业[1] JIAN Shengyan;XIONG Zhengfang;MA Ronghua;ZENG Xianghui;WANG Rui;LI Bingye(Qinghai Province People's Hospital,Xining 810000,China)

机构地区：[1]青海省人民医院生殖医学中心,青海西宁810001

出　　处：《西部医学》2023年第2期256-261,共6页Medical Journal of West China

基　　金：青海省科技合作项目(2019-HZ-823)。

摘　　要：目的探讨高龄卵巢低储备人群在体外受精-胚胎移植(IVF-ET)周期中应用不同促排卵方案的妊娠结局。方法收集在我院生殖医学中心接受IVF助孕的高龄卵巢低储备患者377个周期的临床资料,高孕激素状态下促排卵方案(PPOS组)198个周期、长方案(长方案组)103个周期和拮抗剂方案(拮抗剂组)76个周期。综合评价不同促排卵方案的临床指标。结果长方案组促性腺激素(Gn)的使用总量及使用天数最高,HCG日LH水平最低,MⅡ卵泡成熟度、2PN受精数和优胚数均高于其它两组(P<0.001)。PPOS组获卵率最高,其次为长方案组,均高于拮抗剂组(P<0.001);正常受精拮抗组最高,其次为长方案组,均高于PPOS组(P<0.001);长方案组优胚率最高,与拮抗组比较差异有统计学意义(P<0.05)。在妊娠结局的比较中,长方案组的鲜胚移植率高于拮抗剂组,拮抗剂组的鲜胚移植取消率高于长方案组,但差异均无统计学意义(P>0.05);在累积胚胎种植率的比较中长方案组高于拮抗剂组和PPOS组,其中长方案组与PPOS组差异有统计学意义(P<0.001);长方案组的累积临床妊娠率和累积活产率均高于拮抗剂组和PPOS组,但3组间差异无统计学意义(P>0.05);3组患者流产率差异无统计学意义(P>0.05)。结论高龄卵巢低储备人群在IVF-ET治疗中选择长方案作为促排卵方案,可获得较好的妊娠结局。Objective To evaluate the pregnancy outcomes of the advanced age patients with diminished ovarian reserve who received in vitro fertilization and embryo transfer(IVF-ET)cycle treatment with different ovulation induction programs.Methods The clinical data of 377 cycles of elderly patients with low ovarian reserve who received IVF in the reproductive medicine center of our hospital were collected.There were 198cycles of ovulation induction regimen(PPOS group),103cycles of long regimen(long regimen)and 76 cycles of antagonist regimen(antagonist group).The clinical indexes of different ovulation induction schemes were evaluated comprehensively.Results The total amount and days of gonadotropin(Gn)used in the long regimen group were the highest,and the LH level on HCG day was the lowest.The maturation of MⅡfollicles,the number of 2PN fertilized and the number of excellent embryos were higher than those of the other two groups(P<0.001).The egg acquisition rate of PPOS group was the highest,followed by long regimen group,which was higher than that of antagonist group(P<0.001),the normal fertilization antagonism group was the highest,followed by long regimen group,which was higher than that of PPOS group(P<0.001).In the comparison of pregnancy outcome,the fresh embryo transfer rate of long regimen group was higher than that of antagonist group,and the elimination rate of fresh embryo transfer of antagonist group was higher than that of long regimen group,but there was no significant difference(P>0.001).The cumulative embryo implantation rate of long regimen group was higher than that of antagonist group and PPOS group,and there was significant difference between long regimen group and PPOS group(P<0.001).The cumulative clinical pregnancy rate and cumulative live birth rate in the GnRH-a long protocol group were higher than those in the GnRH-ant protocol group and PPOS group,but there was no significant difference among the three groups(P>0.05).There was no significant difference in abortion rate among the three groups(P

关 键 词：高龄 卵巢低储备 PPOS方案 长方案 拮抗剂方案 

分 类 号：R711.6[医药卫生—妇产科学]