体外受精治疗中促性腺激素的剂量和卵巢反应性与临床结局的关系

Gonadotrophin dose and ovarian response:relations to the clinical outcome of in vitro fertilization and embryo transfer

目的探讨体外受精(IVF)治疗中使用不同促性腺激素(Gn)剂量及卵巢反应性与临床结局的关系。方法在接受IVF治疗、Gn用药时间≤15d的患者中,共551个取卵周期按Gn用量和获卵数进行分组,A组Gn≥3375IU,获卵数≥4个,390个周期;B组Gn≥3375IU,获卵数≤3个,64个周期;C组Gn≤3300IU及获卵数≤3个,97个周期。对3组的多个临床特征及治疗结局进行分析比较。结果A组的临床妊娠率和分娩率分别为38.8%和32.5%,B组为16.7%和10.4%,C组为27.3%和23.4%。A组卵泡数、获卵数、可移植胚胎数、血清E2峰值、临床妊娠率和分娩率均高于B、C组(P<0.05)。A、B组Gn用药剂量均较C组大(P<0.05),B组血清E2峰值、临床妊娠率和分娩率均低于C组,但差异无统计学意义(P>0.05)。结论对Gn用量较低而取卵数少的患者,增加Gn用量能提高临床妊娠率和分娩率,这部分患者应视为相对的卵巢低反应者或轻度卵巢储备功能低下;而增加Gn用量后仍不能增加获卵数者,为真正的卵巢低反应者或重度卵巢储备功能低下,临床预后不佳。

Objective To investigate the association of gonadotrophin （Gn） dose and ovarian response with the clinical outcome of in vitro fertilization and embryo transfer （IVF-ET）. Methods Patients undergoing IVF-ET with Gn stimulation for no more than 15 days were enrolled in this study. The patients were divided into 3 groups, namely group A （390 cycles） with total Gn dose ≥ 3375 IU and retrieved oocytes ≥ 4, group B （64 cycles） with total Gn dose ≥ 3375 IU and retrieved oocytes 3, and group C （97 cycles） with total Gn dose ≤ 3300 IU and retrieved oocytes ≤ 3. The clinical characteristics and outcomes of these 3 groups were comparatively analyzed. Results The clinical pregnancy rate and delivery rate were 38.8% and 32.5% in group A, 16.7% and 10.4% in group B, and 27.3% and 23.4% in group C, respectively. The follicle number, oocyte number, number of embryo transferred, peak serum E2 level, clinical pregnancy rate and delivery rate were significantly higher in group A than in groups B and C （P〈0.05）. Groups B and C had similar follicle number, oocyte number, and number of available embryos, but group C had significantly lower total Gn dose （P〈0.05）; the peak serum E2 level, clinical pregnancy rate and delivery rate were lower in group B than in group C, but the difference was not statistically significant （P〉0.05）. Conclusions In patients receiving a relatively low dose of Gn with smaller number of retrieved oocytes, Gn dose increment can improve the clinical pregnancy rate and delivery rate, suggesting a state of relatively poor ovarian response or mild ovarian reserve decrease; failure of increasing the number of oocytes retrieved with greater Gn dose suggests severey decreased ovarian responsiveness or ovarian reserve and also poor clinical prognosis. Key words： gonadotrophin; poor responders; clinical outcome; IVF