卵泡发育迟缓者在体外受精中延长使用促性腺激素的临床疗效观察

Clinical outcome of patients with follicular development retardation by prolonged duration of gonadotropin administration for in vitro fertilization

目的探讨体外受精(IVF)周期中,卵泡发育迟缓者延长使用促性腺激素(Gn)的临床效果。方法将552个 IVF 周期按 Gn 用药时间、剂量和获卵数分组,观察组(69个取卵周期,66个移植周期):Gn 起始用量为75 IU/d～300 IU/d,用药时间≥16 d,用至卵泡达到取卵标准为止,获卵数≥4个;对照组(483个取卵周期,464个移植周期):Gn 起始用量为150 IU/d～300 IU/d,用药时间≤15 d,且总 Gn 用量≤3300 IU,获卵数≥4个。比较两组患者的 Gn 用量及用药时间、获卵数、临床妊娠率、胚胎着床率及治疗结局。结果观察组和对照组的临床妊娠率分别为45.5%(30/66)和51.7%(240/464);胚胎着床率分别为28.0%(46/164)和30.5%(385/1262);分娩率分别为37.9%(25/66)和39.4%(183/464);两组患者的临床妊娠率、胚胎着床率、分娩率等比较,差异均无统计学意义(P>0.05)。观察组和对照组的多囊卵巢(PCO)和(或)多囊卵巢综合征(PCOS)患者的比例分别为55.1%(38/69)和20.1%(97/483);基础窦卵泡数分别为(20±11)个和(15±6)个;Gn 用药时间分别为(20.8±4.2)d 和(10.3±1.8)d;Gn 用药总量分别为(3090±1140)IU 和(2302±862)IU;血清雌二醇峰值分别为(4595±5181)pmol/L 和(7272±6320)pmol/L;获卵数分别为(10±6)个和(14±7)个;移植胚胎数分别为(2.5±0.6)个和(2.7±0.5)个;两组上述各指标比较,差异均有统计学意义(P<0.01)。结论对 IVF 周期中卵泡发育迟缓的患者,延长使用 Gn 有效、方便,能获得满意的临床结局。

Objective To investigate prolonged use of gonadotropin （Gn） stimulation for the patients with follicular development retardation during controlled hyperstimulation （COH） for in vitro fertilization （IVF） cycles. Methods The inclusion criteria to categorize the good responder were that duration of Gn stimulation was ≤15 days, total Gn dose used was ≤3300 IU and total oocytes retrieved were ≥4. The inclusion criteria for prolonged duration of Gn stimulation were that duration of stimulation was ≥ 16 days. There were 69 oocyte retrieval cycles and 66 transfer cycles in prolonged stimulation group （ group 1 ） and 483 oocyte retrieval cycles and 464 transfer cycles in good ovarian response group （ group 2 ）. The clinical characteristics and outcomes of two groups were analyzed. Results Clinical 5 pregnancy rate, implantation rate and delivery rate were 45.5% （30/66） versus 51.7% （240/464）, 30. 5% （385/1262） versus 28.0% （46/164） and 37.9% （25/66） versus 39.4% （ 183/464）, respectively, in groups 1 and 2. Duration of Gn stimulation and dose were （20. 8 ±4. 2） and （10. 3 ±1.8） days, （3090 ± 1140）and （2302±862） IU in groups 1 and 2, respectively. There was no statistical difference in patient＇s age, basal follicular stimulating hormone （ FSH）, clinical pregnancy rate, implantation rate, early miscarriage rate, ovarian hyperstimulation syndrome （OHSS） rate, delivery rate between two groups （ P 〉 0. 05 ）. There were more polycystic ovary （PCO） and （or） polycystic ovarian syndrome （PCOS） patients, more basal antral follicles, longer duration of Gn stimulation （ range 16 - 33 days ） , higher Gn dose, lower serum peak estradiol （E2 ） level, fewer oocytes, fewer embryos transferred, in group 1 compared with group 2 （ P 〈 0. 01）. Conclusions These results demonstrate that prolonged Gn stimulation more than 16 days is a valuable alternative before cancellation of the IVF cycles for follicular development retardation during COH. Good clinical outcome can be achieved including pregnancy rate, implantation rate and delivery rate.