来曲唑微刺激促排卵方案在卵巢低反应患者中的应用

Application of mini-stimulation protocol of letrozole in the patients with ovarian poor response

目的:探讨来曲唑微刺激促排卵方案在卵巢低反应患者体外受精-胚胎移植中的应用。方法:回顾性分析进行IVF/ICSI助孕的卵巢低反应患者共79个周期。根据促排卵方案分为两组:A组(来曲唑微刺激组):共35个周期,B组(常规短方案组):共44个周期。比较两组的Gn用量、平均获卵数、提前排卵周期率、受精率、可利用胚胎率、优胚率、临床妊娠率等各项指标。结果:①两组患者的平均年龄、不孕年限、基础内分泌水平比较,差异无统计学意义(P>0.05);②hCG注射日血清LH水平A组明显高于B组(P<0.05),血清E2水平、Gn的天数及用量B组明显高于A组,差异有统计学意义(P<0.05),内膜厚度两组差异无统计学意义(P>0.05);③A组提前排卵率(22.86%)显著高于B组(0%),差异有统计学意义(P<0.05),两组的平均获卵数、受精率、卵裂率、移植率、可利用胚胎率、优胚率比较,差异无统计学意义(P>0.05);④A组临床妊娠率(31.58%)明显高于B组(19.35%),但差异无统计学意义(P>0.05)。结论:卵巢低反应患者IVF/ICSI-ET促排卵周期应用来曲唑微刺激方案可以获得与GnRH-a短方案相近的临床效果,同时降低Gn使用总量、减轻患者单周期治疗费用。

Objective：To explore the application of mini-stimulation protocol of letrozole in in vitro fertilization and embryo transfer（IVF-ET） among patients with ovarian poor response. Methods：79 cycles of the patients with ovarian poor response receiving IVF/ICSI were analyzed retrospectively,then they were divided into group A（letrozole mini-stimulation protocol group,35 cycles） and group B（conventional short protocol,44 cycles）.The indexes including the doses of gonadotropic hormone,average numbers of retrieved oocytes,the cycle rates of advanced ovulation,fertilization rates,available embryo rates,high quality embryo rates and clinical pregnancy rates in the two groups were compared. Results：There was no significant difference in average age,infertile time and basic endocrine level between the two groups（P0.05）.The serum level of luteinizing hormone on the day of human chorionic gonadotropin（HCG） injection in group A was significantly higher than that in group B（P0.05）;the serum estradiol level,administration time and dose of gonadotropic hormone in group B were significantly higher than those in group A（P0.05）;there was no significant difference in the depth of endometrium between the two groups（P0.05）;the rate of advanced ovulation in group A was 22.86%,which was significantly higher than that in group B（0%）（P0.05）;there was no significant difference in average number of retrieved oocytes,fertilization rate,cleavage rate,implantation rate,available embryo rate and high quality embryo rate between the two groups（P0.05）.The clinical pregnancy rate in group A was 31.58%,which was higher than that in group B（19.35%）,but there was no significant difference（P0.05）. Conclusion：Mini-stimulation protocol of letrozole can obtain similar clinical efficacy with gonadotropin releasing hormone agonist（GnRH-a） short protocol during IVF/ICSI-ET ovulation cycle for the patients with ovarian poor response,meanwhile,it can reduce the total administration dose of gonadotropic hormone and the treatment cost of patients receiving monocyclic treatment.