卵巢低反应人群IVF-ET中采取拮抗剂方案与PPOS方案的疗效比较  

Comparison of the efficacy of antagonist and PPOS regiments in IVF-ET in patients with poor ovarian response

作　　者：高商 宁艳春[1] 姚雨宏 郭畅[1] 丰程文 刘宝莲[1] GAO Shang;NING Yanchun;YAO Yuhong;GUO Chang;FENG Chengwen;LIU Baolian(Department of Reproductive Genetics,Tangshan Maternal and Child Health Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]河北省唐山市妇幼保健院生殖遗传科,河北唐山063000

出　　处：《检验医学与临床》2024年第10期1415-1419,共5页Laboratory Medicine and Clinic

基　　金：河北省医学科学研究课题计划项目(20231746)。

摘　　要：目的探讨拮抗剂方案与高孕激素促排卵(PPOS)方案在卵巢低反应人群体外受精-胚胎移植(IVF-ET)中的应用效果。方法选择该院2018年1月至2022年7月就诊的卵巢低反应患者128例为研究对象,根据促排卵方案不同分为拮抗剂组和PPOS组,每组64例。比较两组重组人绒毛膜促性腺素(HCG)注射日性激素水平[孕酮(P)、卵泡刺激素(FSH)、雌二醇(E_(2))、促黄体生成素(LH)]、卵泡周围血流参数[搏动指数(PI)、收缩期最大血流速度(PSV)、阻力指数(RI)、动脉收缩期峰值流速/舒张末期血流速度(S/D)]、血清生长分化因子-9(GDF-9)、骨形态发生蛋白-15(BMP-15)及促排卵情况、胚胎质量、妊娠结局。结果PPOS组HCG注射日血清E_(2)、BMP-15水平及PSV、优势卵泡数、可移植胚胎数、获卵数、成熟卵数、优质胚胎数、两原核(2PN)受精数、临床妊娠率、活产率大于或高于拮抗剂组,LH水平、周期取消率、流产率低于拮抗剂组,差异均有统计学意义(P<0.05)。结论在卵巢低反应人群IVF-ET中,与拮抗剂方案相比,PPOS方案可通过调节性激素水平,改善卵泡周围血流参数及BMP-15水平,提升促排卵效果,改善胚胎质量及妊娠结局。Objective To investigate the effect of antagonist regimen and high progesterone stimulates ovulation(PPOS)regimen on in vitro fertilization-embryo transfer(IVF-ET)in patients with poor ovarian response.Methods A total of 128 cases patients with poor ovarian response who were treated in Tangshan Maternal and Child Health Hospital from January 2018 to July 2022 were selected and divided into antagonist group and PPOS group according to different ovulation induction regiments,64 cases in each group.The levels of sex hormone[progesterone(P),follicle-stimulating hormone(FSH),estradiol(E_(2)),luteinizing hormone(LH)],blood flow parameters around the follicle[pulse index(PI),peak systolic blood flow velocity(PSV),resistance index(RI),peak systolic flow velocity/end-diastolic blood flow velocity ratio(S/D)],serum growth differentiation factor-9(GDF-9),bone morphogenetic protein-15(BMP-15)on human chorionic gonadotropin(HCG)day,ovulation promotion,embryo quality,pregnancy outcome in the two groups were compared.Results The levels of serum E_(2) and BMP-15 on HCG day,PSV,number of dominant follicles,number of transferrable embryos,number of retrieved oocytes,number of mature oocytes,number of high-quality embryos,number of two-pronucleus(2PN)fertilization,clinical pregnancy rate and live birth rate in PPOS group were greater or higher than those in antagonist group,and the level of LH,cycle cancellation rate and abortion rate were lower than those in antagonist group,the differences were statistically significant(P<0.05).Conclusion Compared with antagonist regimen,PPOS regimen can improve blood flow parameters around the follicle and BMP-15 levels by regulating sex hormone levels,promote ovulation effect,improve embryo quality and pregnancy outcome in IVF-ET population with poor ovarian response.

关 键 词：卵巢低反应 体外受精-胚胎移植 高孕激素促排卵 拮抗剂 妊娠结局 

分 类 号：R711.59[医药卫生—妇产科学]