不同促排卵方案在卵巢低反应患者中的应用

Different Ovarian Stimulation Protocols in Application of Patients with Poor Response

目的:探讨不同促排卵方案在接受体外受精-胚胎移植(IVF-ET)的卵巢低反应患者中的应用价值。方法:对87例卵巢低反应患者采用不同方案进行IVF/ICSI-ET共200个周期的临床资料进行回顾性分析,其中短方案者50个周期(A组),拮抗剂方案者39个周期(B组),微刺激方案者93个周期(C组),自然周期方案者18个周期(D组)。比较分析各组的促排卵结局。结果:4组间周期取消率无统计学差异,hCG注射日LH水平A组低于其他3组,E2水平高于其他3组,与C、D组比有统计学差异(P<0.05),优势卵泡数及平均获卵数D组低于其他3组,而正常受精率高于其他3组,与A、B组比有统计学差异(P<0.05),hCG注射日内膜厚度、P值、MⅡ卵率、可利用胚胎率、临床妊娠率C组临床妊娠率略高,但各组间差异均无统计学意义(P>0.05)。结论:对卵巢低反应患者微刺激方案在IVF-ET促排卵中相对其他方案有更好的临床效果。

Objective：To discuss the effectiveness of different stimulation protocols in patients with poor response who undergone IVF-ET treatment.Methods：A method of retrospective study was used in the clinical document of 87 patients with poor response who undergone 200 cycles in IVF/ICSI-ET,the patients were divided into 4 groups：50 cases in group A（GnRH-a short protocol）,39 cases in group B（GnRH-ant protocol）,93 cases in group C（micro-stimulation protocol）,18 cases in group D（natural protocol）.The cancelled cycle rate,the number of follicle ≥14 mm on the day of hCG administration,the endometrial thickness on the day of hCG administration,LH levels,E2 levels and P levels on the day of hCG administration,the number of retrieved oocytes,the rate of MⅡ oocyte,normal fertilization rate,can be used embryo rate,clinical pregnancy rate were compared between the 4 groups.Results：Overall among the 4 groups there was no significant difference of cycle cancellation,LH levels on the day of hCG administration in group A were lower than the other three groups,E2 levels were higher than the other 3 groups,the difference was statistically significant compared with group C and group D（P0.05）,dominant follicle and the average number of oocytes in group D were lower than those in the other 3 groups,and normal fertilization rate was higher than that in the other 3 groups,the difference was significant compared with group A and group B（P0.05）,4 groups of endometrial thickness on the hCG day,P levels,the rate of MⅡ oocyte,can be used embryo rate,clinical pregnancy rate were not significantly different（P0.05）.In micro-stimulation group,the clinical pregnancy rate was slightly higher.Conclusion：The micro-stimulation protocol can achieve better clinical results than other protocols in patients with poor response who undergone IVF-ET treatment.