不同类型孕激素的高孕激素状态下促排卵方案在高龄卵巢储备功能减退患者中的应用研究  

Application of progestin-primed ovarian stimulation scheme with different kinds of progesterone in patients at advanced age with decreased ovarian reserve

作　　者：林冰 文琴 梅凤琦 张兰琴 黄俊花 庞颖仪 梁洁珩 梁丽能 何嘉欣 陈姚 甄国志 LIN Bing;WEN Qin;MEI Feng-qi;ZHANG Lan-qin;HUANG Jun-hua;PANG Ying-yi;LIANG Jie-heng;LIANG Li-neng;HE Jia-xin;CHEN Yao;ZHEN Guo-zhi(Reproductive Center,Institute of Reproductive Medicine,Shunde Women&Children’s Hospital of Guangdong Medical University(Maternal&Child Healthcare Hospital of Shunde,Foshan),Foshan 523800)

机构地区：[1]广东医科大学顺德妇女儿童医院(佛山市顺德区妇幼保健院)生殖中心,生殖医学研究所,佛山528000

出　　处：《生殖医学杂志》2024年第10期1282-1287,共6页Journal of Reproductive Medicine

基　　金：“佛山名医”项目(10000015Z155080000004);佛山市医学类科技攻关项目(2220001004494);本院青年人才项目(2023QNRC017)。

摘　　要：目的探讨不同类型孕激素的高孕激素状态下促排卵方案(PPOS)应用于高龄卵巢储备功能减退(DOR)患者IVF/ICSI周期中的有效性。方法选择2023年1月至2024年3月在我院生殖中心运用PPOS方案行IVF/ICSI助孕治疗的高龄DOR不孕患者为研究对象,共150个周期。根据随机数字表法随机分为3组:安宫黄体酮组(A组)、安琪坦组(B组)及地屈孕酮组(C组),每组各50个周期。比较3组患者的一般资料、促排卵情况及胚胎实验室相关指标。结果3组患者间一般资料比较均无显著性差异(P>0.05)。3组患者间促性腺激素(Gn)总量、Gn天数、扳机日E 2、LH水平及卵泡数、获卵数、扳机后提前排卵率、D3优质胚胎数比较均无显著性差异(P>0.05);B组的扳机日孕酮水平显著高于A组和C组[(24.19±16.74)nmol/L vs.(2.25±0.98)nmol/L、(5.93±2.19)nmol/L,P<0.05];B组的未获卵率有低于其他两组的趋势,MⅡ卵率、受精率、正常受精率、可利用胚胎数有高于其他两组的趋势,但尚无显著性差异(P>0.05);C组的促排卵失败率及无可利用胚胎率有高于其他两组的趋势,但尚无显著性差异(P>0.05)。结论高龄DOR不孕患者采用PPOS方案进行促排卵治疗时,选用黄体酮软胶囊可以获得与醋酸甲羟孕酮及地屈孕酮相似的胚胎结局,可作为临床用药的选择之一。Objective:To explore the safety and effectiveness of progestin-primed ovarian stimulation(PPOS)with different kinds of progestin in IVF/ICSI cycles among patients at advanced age with diminished ovarian reserve(DOR).Methods:Infertility patients of advanced age with DOR,who underwent IVF/ICSI assisted pregnancy treatment using PPOS protocol(150 cycles in total)at Reproductive Center of Institute of Reproductive Medicine,Shunde Women&Children’s Hospital of Guangdong Medical University from January 2023 to March 2024 were recruited.The patients were randomly assigned to three groups based on the type of progestin used as medroxyprogesterone acetate group(Group A),progesterone capsules group(Group B)and dydrogesterone group(Group C),with 50 patients in each group.The general characteristics,ovulation induction and embryonic laboratory indicators of three groups of patients were compared.Results:There were no significant differences in general characteristics among the three groups(P>0.05).Similarly,no significant differences were found in total gonadotropin(Gn)dose,the duration of Gn used,estradiol(E 2)and LH levels on the trigger day,follicle count,oocyte retrieval count,premature ovulation rate after trigger,and the number of good-quality embryos on Day 3(P>0.05).The serum progesterone levels on the trigger day in Group B were significantly higher than those in other two groups[(24.19±16.74)nmol/L vs.(2.25±0.98)nmol/L,(5.93±2.19)nmol/L,P<0.05].Although no statistical significance,Group B exhibited a trend towards a lower non-oocyte retrieval rate and higher MⅡrate,the fertilization rate,normal fertilization rate,and available embryo count when compared with the other groups(P>0.05).Group C showed a tendency for a higher ovulation failure rate and non-available embryo rate,with no statistical significance similarly(P>0.05).Conclusions:In DOR patients at advanced age undergoing the ovulation promotion with the PPOS protocol,the use of progesterone soft capsules yielded similar embryo outcomes compared to medro

关 键 词：高孕激素状态下促排卵方案 卵巢储备功能减退 孕激素 体外受精/卵胞浆内单精子注射 

分 类 号：R711.6[医药卫生—妇产科学]