五种促排卵方案在卵巢储备功能下降患者中临床用药与结局的比较

Differences of clinical medication and outcomes in the patients with decreased ovarian reserve treated with different controlled ovarian hyperstimulation schemes

目的探讨微刺激方案、改良超长方案、短方案、拮抗剂方案及自然周期方案在卵巢储备功能下降(DOR)患者中临床用药与结局的差异。方法微刺激方案(A组)129个周期,改良超长方案(B组)129个周期,短方案(C组)58个周期,拮抗剂方案(D组)48个周期,自然周期方案(E组)37个周期。对5组方案中患者的促性腺激素(Gn)用量、天数、人绒毛膜促性腺激素(hCG)注射日内膜厚度、获卵数、可移植胚胎数、胚胎种植率、临床妊娠率、周期取消率、流产率等进行比较。结果 A、B、C组的Gn天数分别为(8.5±2.1)、(12.3±3.0)和(9.9±2.7)天,hCG注射日子宫内膜厚度分别为(9.1±1.8)、(10.5±2.3)和(8.9±1.6)mm,A、B、D组的Gn用量分别为(19.8±7.6)、(34.9±11.9)和(39.5±12.2)支,A、B、E组的获卵数分别为(4.1±1.3)、(3.0±2.0)和(1.0±0.4)个,A、E两组分别和B组差异有显著性(P<0.05);B、E组的可移植胚胎数分别为(2.0±2.0)和(0.7±0.7)个,差异有显著性(P<0.05);B、C、E组的临床妊娠率分别为37.2%(35/94)、19.1%(9/47)和18.2%(2/11),B组和C、E组有显著性差异(P<0.05);五组流产率、胚胎种植率差异无显著性(P>0.05)。结论 DOR患者在体外受精-胚胎移植(IVF-ET)五种促排卵方案中,改良超长方案用药量大、持续时间长,但与其他方案相比具有更好的临床结局,值得进一步推广应用。

Objective： To investigate the differences of clinical medication and outcomes in the patients with decreased ovarian reserve （DOR） treated with five controlled ovarian hyperstimulation protocols. Methods： A total of 87 DOR patients were treated with different protocols of controlled ovarian hyperstimulation, which included 129 cycles of minimal ovarian stimulation （Group A）, 129 cycles of modified ultra-long protocol （Group B）, 58 cycles of short protocol （Group C）, 48 cycles of gonadotropin releasing hormone antagonist（GnRH-ant） protocol （Group D） and 37 cycles of natural cycle （Group E）. The endometrium thickness on hCG injection day, and Gn doses and duration of use were compared among five groups. Other parameters related to clinical outcomes, such as number of oocytes retrieved, number of transferable embryos, implantation rate, clinical pregnancy rate, abortion rate and cycle cancellation rate were also compared. Results： The administration days of Gn in Group B （12.3±3.0） were longer than those in group A （8.5±2.1） or group C （9.9±2.7）. The endometrium on hCG injection day in Group B （10.5±2.3 mm）was significantly thicker than in Group A （9.1±1.8 mm） and Group C （8.9±1.6 mm）. The ampules of Gn used in Group B （34.95±11.9） was significant more than those in Group A （19.85=7.6） and Group D （39.55±12.2） （P〈0.05）. The oocytes retrieved in Group B （3.05±2.0） were significantly more than in Group A （4. 1±1.3） and Group E （1.05±0.4） （P〈0.05）. The transferable embryos in Group B （2.05± 2.0） were significantly more than in Group E （0. 75±0. 7） （P〈0. 05）. The clinical pregnancy rate in Group B （37.2%, 35/94） was significantly higher than that in Group C （19.1%, 9/47） and Group E （18.2%, 2/11） （P〈0.05）, No significant difference was found in abortion rate and implantation rate among the five groups （P〉0.05）. Conclusions： Modified ultra-long protocol was characterized by higher Gn dosage and longer duration of use among five protocols for the DOR patients. However, the clinical outcomes of this protocol were better than the other protocols.