体外受精-胚胎移植中卵巢低反应54例临床分析

Clinical analysis on 54 cases with ovarian poor response in in vitro fertilization-embryo transfer

目的:探讨体外受精-胚胎移植/卵母细胞质内单精于注射(IVF/ICSl-ET)中卵巢低反应发生的相关因素及结局分析。方法:回顾分析2008年1月～2009年8月采用激动剂短方案控制性超排卵(COH)的患者,同时满足①经阴道超声下取卵,获卵数<3个,②HCG日E2<500 Pg/ml为卵巢低反应标准,取同期采用激动剂短方案COH患者获卵4～20个为正常反应组,即对照组(203例),分析两组的年龄、窦卵泡数、基础FSH(bFSH)、基础LH(bLH)、基础E2(bE2)、周期取消率、Gn用量、平均用药天数、受精率及临床妊娠率等。结果:两组患者比较,低反应组年龄、bFSH、周期取消率、卵巢手术史比率明显高于对照组(P<0.001),Gn用量两组相比有非常显著性差异(P<0.001),窦卵泡数、临床妊娠率明显低于对照组(P<0.001),受精率两组相比有显著性差异(P<0.05),而不孕年限、bE2、bLH、平均用药天数两组相比无明显差异(P>0.05)。结论:患者年龄、bFSH、窦卵泡数、有卵巢手术史可预测卵巢低反应的发生,卵巢低反应患者Gn刚量大,临床妊娠预后差。

Objective： To explore the related factors of ovarian poor response in in vitro fertilization - embryo transfer （IVF - ET） /intraeytoplasmic sperm injection （ICSI）, analyze the outcome of IVF -ET/ICSI. Methods： The patients receiving controlled ovarian hyperstimulation （COH） with short protocol of agonist from January 2008 to August 2009 were analyzed retrospectively, all the patients met the criteria of ovarian poor response ： the oocytes were obtained under transvaginal uhrasonography, the number of ooeytes retrieved was less than three; the level of estradiol 〈 500 pg/ml on the day of human ehorionic gonadotropin （HCG） injection. The patients receiving COH with short protocol of agonist and obtaining 4 -20 oocytes were selected as normal ovarian response group （control group, 203 cases） . The ma- ternal ages, the numbers of antral follicles, basic follicle - stimulating hormone （bFSH） levels, basic luteinizing hormone （bLH） levels, basic estradiol levels, the cycle cancellation rates, the administration doses of gonadotropin, the average administration times, the fertiliza- tion rates, and clinical pregnancy rates in the two groups were analyzed. Results： The age, bFSH level, the cycle cancellation rate, and the rate of ovarian surgical history in ovarian poor response group were significantly higher than those in control group （ P 〈 0. 001 ）, and there was significant difference in the administration dose of gonadotropin between the two groups （P 〈 0. 001 ） ; the number of antral follicles and clinical pregnancy rate in ovarian poor response group were significantly lower than those in control group （ P 〈 0. 001 ）, and there was significant difference in the fertilization rate between the two groups （ P 〈 0. 05 ）, but there was no significant difference in the duration of infertility, basic estradiol level, bLH level, and the average administration time between the two groups （ P 〉 0. 05 ） . Conclusion： The maternal age, bFSH level, the number of antral follicles, and ovarian surgical history can predict the occurrence of ovarian poor response, the admin- istration dose of gonadotropin in the patients with ovarian poor response is high, the prognosis of clinical pregnancy is poor.