摘要
目的比较不同促排卵方案应用于卵巢低反应(POR)患者的临床实验室效果,探讨POR患者适宜的促排卵方案。方法回顾性分析2014年7月1日至2017年6月30日期间于我院生殖中心接受IVF/ICSI-ET助孕的POR患者共142个周期,根据不同促排方案分成3组:卵泡期高孕激素状态下促排卵方案(PPOS)组(29个周期),微刺激组(81个周期),拮抗剂组(32个周期)。比较3组患者的一般资料、促排卵情况、实验室指标及周期异常情况等。结果 3组患者的一般资料比较均无显著性差异(P>0.05);3组患者的促排天数、Gn用量、性价比、平均获卵所需Gn用量、HCG日E2水平、LH水平比较,组间均有显著性差异(P<0.05)。PPOS组促排天数最长,Gn用量最少,平均获卵所需Gn量最低,每获胚费用最低;微刺激组HCG日E2水平及LH水平最高;拮抗剂组HCG日LH水平最低,促排天数最短,Gn用量最大,平均获卵所需Gn量最大,费用最高(P均<0.05)。PPOS组及拮抗剂组均无早发LH峰出现,微刺激组中有21个周期发生早发LH峰,发生率25.93%。3组不同方案中获卵数组间比较有显著性差异(P<0.05);成熟卵率、正常受精率、正常卵裂率、可利用胚胎率、优质胚胎率及周期异常情况发生率组间比较均无显著性差异(P>0.05)。结论对于POR患者,拮抗剂方案可以抑制LH峰,获卵数高,周期花费高;微刺激方案在晚卵泡期添加促性腺激素释放激素拮抗剂(GnRH-ant)可控制LH峰,获得较好的优胚率及可利用胚胎率;PPOS方案能有效抑制LH峰,Gn用量少、花费小,但需行冻融胚胎移植。
Objective：To compare the clinical and laboratory data of different ovarian stimulation protocol in the patients with poor ovarian responders（POR）,in order to explore the optimal ovarian stimulation protocol for POR patients.Methods： A retrospective analysis was performed in 1 4 2 POR patients received ICSI in our hospital from July 1 2014 to June 30 2017.According to different ovarian stimulation protocol,the cycles were divided into 3 groups：group A（progestin-primed ovarian stimulation,PPOS,29 cycles）,group B（mild ovarian stimulation group,81 cycles）,group C（antagonist group,32 cycles）.The clinical data,ovarian stimulation status,laboratory indexes and abnormal cycle rate were compared among the three groups.Results：There were no significant differences in the general data among the three groups（P〈0.05）.There were significant differences in ovarian stimulation days,dosage of gonadotropin（Gn）used,average cost per cycle,average dosage of Gn used per oocyte retrieved,the level of E2 and LH on HCG day（P〉0.05）.In group A,the ovarian stimulation days were the longest,the dosage of Gn used and the average dosage of Gn used per oocyte retrieved was the least,and the cost per embryo was the lowest.In group B,levels of LH E2 on HCG day were the highest.In group C,the LH levels on HCG day were the lowest,the ovarian stimulation days were the shortest,and the total dosage of Gn and the average dosage of Gn used per oocyte retrieved were the most.All the P values were less than 0.05.There were no premature LH surge occurred in group A and C,but 21 cycles occurred in the B group with the incidence of 25.93%.There was significant difference in number of oocytes retrieved among the three groups（P〈0.05）.There were no significant differences in mature oocyte rate,normal fertilization rate,normal cleavage rate,available embryo rate,high quality embryo rate and abnormal cycle rate among the three groups（P〉0.05）.Conclusions：For POR patients,the antagonist protocol can inhibit the premature LH and obtain higher number of oocytes,but has higher cost per cycle.Addition GnRH antagonist at the late follicular phase can control the premature LH surge,and obtain a better embryo rate and available embryo rate in ovarian stimulation group.PPOS protocol can effectively prevent premature LH surge,uses less dosage of Gn and has less cost per cycle,but need frozen-thawed embryo transplantation.
作者
刘敏
张建梅
梁莹
粟妤
肖亚玲
姚小艳
李建军
LIU Min;ZHANG Jian-mei;LIANG Ying;SU Yu;XIAO Ya-ling YAO Xiao-yan;LI Jian-jun(Center for Reproductive Medicine,Changsha Hospital for Maternal and Child Health Care,Changsha 410007)
出处
《生殖医学杂志》
CAS
2018年第9期898-903,共6页
Journal of Reproductive Medicine
