卵泡期高孕激素状态下促排卵在卵巢储备功能低下患者中的应用

摘要
图/表
参考文献
相关文章 (5)

全文: PDF (1341 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：比较3种不同的促排方案在卵巢储备功能低下（DOR）患者中促排的胚胎实验室结局，以探索卵泡期高孕激素状态下促排卵（PPOS）在DOR患者中的应用价值。方法：回顾性分析2015年11月至2016年7月期间来温州医科大学附属第二医院育英儿童医院生殖中心接受体外受精/胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）治疗的DOR患者共228周期，根据促排情况分成3组：A组（卵泡期PPOS方案组，87周期），B组（黄体期促排卵方案组，45周期），C组（微刺激方案组，96周期）。比较3组的一般情况和促排结局。结果：B组的促性腺激素（Gn）用量显著多于A组和C组，差异有统计学意义（P＜0.05），但3组的Gn用药天数差异无统计学意义（P＞0.05）；A组D3优质胚胎率显著高于C组，差异有统计学意义（P＜0.05）；但A组与B组、B组与C组间差异均无统计学意义（P＞0.05）；B组注射人绒毛膜促性腺激素（HCG）日黄体生成素（LH）水平显著低于A组和C组，差异有统计学意义（P＜0.05）；B组HCG日孕酮（P）水平显著高于C组，差异有统计学意义（P＜0.05）；A组HCG日P水平与C组比差异无统计学意义（P＞0.05）；3组间的获卵数、成熟卵数、正常受精卵数、卵裂数、D3优质胚胎数、有效胚胎数、正常受精率、卵裂率、有效胚胎率差异均无统计学意义（P＞0.05）。结论：对于DOR患者，卵泡期PPOS方案可以获得更好的D3优质胚胎率，可为此类患者提供一种新的备选促排卵方案。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	付养华
	杨榃楚
	习海涛
	赵军招

关键词 ：卵巢储备功能低下, 体外受精-胚胎移植, 高孕激素状态, 微刺激

Abstract：Objective: To compare the embryo laboratory outcomes of different ovarian stimulation schemes in patients with diminished ovarian reserve, to explore the application value of progestin-primed ovarian stimulation scheme in patients with diminished ovarian reserve. Methods: A total of 228 cycles of patients with diminished ovarian reserve who received IVF/ICSI-ET treatment from November 2015 to July 2016 were analyzed retrospectively. They were divided into progestin-primed ovarian stimulation (Group A, 87 cycles), luteal-phase stimulation (Group B, 45 cycles) and mild stimulation (Group C, 96 cycles) according to treatment protocols. The basic situations and the embryo laboratory outcomes were compared and analyzed between Group A, Group B and Group C. Results: The basic situations in three groups were no significant differences (P>0.05). The dosage of Gn administration in Group B was significantly higher than those in Group A and Group C (P<0.05). The D3 quality embryo rate in Group A was significantly higher than Group C (P<0.05). The serum LH level of the patients in Group B on the day of HCG administration was significantly lower than that in Group A and Group C (P<0.05). The serum P level of the patients in Group B on the day of HCG administration was significantly higher than Group C (P<0.05). There were no significant differences in the retrieved oocytes number, mature oocytes number, D3 good-quality embryos number, available embryos number, the normal fertilization rate, the cleavage rate, the available embryo rate among three groups (P>0.05). Conclusion: Progestin-primed ovarian stimulation scheme can obtain higher D3 quality embryo rate and is a viable regimen for patients with diminished ovarian reserve.

Key words： diminished ovarian reserve in vitro fertilization-embryo transfer high progesterone status mild stimulation

收稿日期: 2016-09-18

通讯作者: 赵军招，主任医师，教授，Email：z.jocye08@163.com。

作者简介: 付养华（1990-），男，江西抚州人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I4/258

[1] GURTCHEFF S E, KLEIN N A. Diminished ovarian reserve and infertility[J]. Clin Obstet Gynecol, 2011, 54(4): 666-674.
[2] KUANG Y P, CHEN Q J, HONG Q Q, et al. Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes (Shanghai protocol)[J]. Reprod Biomed Online, 2014, 29(6): 684-691.
[3] 叶静, 陈秋菊, 匡延平. 卵巢功能正常患者高孕激素状态下促排卵的内分泌特征及IVF/ICSI临床结局的研究[J]. 生殖与避孕, 2015, 35(6): 393-400.
[4] 朱秀娴, 陈秋菊, 匡延平. 卵巢功能正常患者使用不同促性腺激素联合安宫黄体酮促排卵的IVF/ICSI-FET结局[J]. 生殖与避孕, 2015, 35(5): 310-317.
[5] 李玉梅, 巴林林, 刘冬娥, 等. 卵泡期联合黄体期促排卵在卵巢储备功能减退患者实施辅助生殖技术中的应用[J]. 生殖医学杂志, 2014, 23(9): 728-732.
[6] COHEN J, CHABBERT-BUFFET N, DARAI E. Diminished ovarian reserve, premature ovarian failure, poor ovarian responder—a plea for universal definitions[J]. J Assist Reprod Genet, 2015, 32(12): 1709-1712.
[7] LEE T H, LIU C H, HUANG C C, et al. Impact of female age and male infertility on ovarian reserve markers to predict outcome of assisted reproduction technology cycles[J]. Reprod Biol Endocrinol, 2009, 7(1): 1-10.
[8] LU Q, SHEN H, LI Y, et al. Low testosterone levels in women with diminished ovarian reserve impair embryo implantation rate: a retrospective case-control study[J]. J Assist Reprod Genet, 2014, 31(4): 485-491.
[9] LEVI A J, RAYNAULT M F, BERGH P A, et al. Reproductive outcome in patients with diminished ovarian reserve[J].Fertil Steril, 2001, 76(4): 666-669.
[10] LOUTRADIS D, DRAKAKIS P, VOMVOLAKI E, et al.Different ovarian stimulation protocols for women with diminished ovarian reserve[J]. J Assist Reprod Genet, 2007, 24(12): 597-611.
[11] 徐千花, 曹云霞, 魏兆莲, 等. 不同促排卵方法在卵巢储备功能下降患者中的应用[J]. 生殖与避孕, 2009, 29(1): 51-54, 41.
[12] 张娟, 方小玲, 李辉, 等. 五种促排卵方案在卵巢储备功能下降患者中的临床疗效观察[J]. 生殖医学杂志, 2012, 21(6): 578-583.
[13] REVELLI A, CASANO S, SALVAGNO F, et al. Milder is better? Advantages and disadvantages of “mild” ovarian stimulation for human in vitro fertilization[J]. Reprod Biol Endocrinol, 2011, 9(1): 1-9.
[14] WEI L H, MA W H, TANG N, et al. Luteal-phase ovarian stimulation is a feasible method for poor ovarian responders undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer treatment compared to a GnRH antagonist protocol: A retrospective study[J]. Taiwan J Obstet Gynecol, 2016, 55(1): 50-54.
[15] KUANG Y P, Hong Q Q, Chen Q J, et al. Luteal-phase ovarian stimulation is feasible for producing competent oocytes in women undergoing in vitro fertilization/intracyto-plasmic sperm injection treatment, with optimal pregnancy outcomes in frozen-thawed embryo transfer cycles[J]. Fertil Steril, 2014, 101(1): 105-111.
[16] KUANG Y P, Chen Q J, FU Y L, et al. Medroxyprogester-one acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization[J]. Fertil Steril, 2015, 104(1): 62-70.
[17] 朱光丽, 吕玉珍, 宋文月. 人工黄体期促排卵在卵巢储备功能低下患者中的应用[J]. 现代妇产科进展, 2016, 25(4):273-276.
[18] WONG K M, MASTENBROEK S, REPPING S. Cryopreservation of human embryos and its contribution to in vitro fertilization success rates[J]. Fertil Steril, 2014, 102(1): 19-26.