自然周期与超促排卵方案在卵巢低储备低反应患者中的临床应用

Clinical applications of natural cycle and controlled ovarian hyperstimulation in the patients with ovarian low reserve and low response

目的:探讨自然周期体外受精-胚胎移植(NC-IVF-ET)和超促排卵周期体外受精-胚胎移植(COH-IVF-ET)在卵巢低储备低反应患者中的临床应用价值。方法:回顾性分析2007年6月～2010年12月接受IVF治疗的170名卵巢储备功能降低的低反应患者共249个IVF治疗周期,按治疗方案分为A组(NC-IVF-ET组)(87周期)和B组(COH-IVF-ET组)(162周期);有24名患者先后行过两种方案共66个治疗周期,同样按方案分为C组(NC-IVF组)(36周期)和D组(COH-IVF组)(30周期)。使用spss13.0统计软件分别对各分组的一般情况、治疗情况及结局行对照分析。结果:A组患者年龄较B组小,窦状卵泡数(AFC)较少,基础卵泡刺激素(FSH)较高,但两组不孕年限差异无统计学意义;A组患者的促性腺激素(Gn)用量、HCG日的雌二醇(E2)水平、内膜厚度及各径线的卵泡数均低于B组;A组较B组抽吸的卵泡数、获卵数、移植胚胎数均较少,获卵率较低,周期取消率较高,差异有统计学意义;而两组间正常受精率、卵裂率、优质胚胎率、胚胎种植率、移植周期的临床妊娠率及早期自然流产率比较差异均无统计学意义。C组年龄和窦状卵泡数较D组低,基础FSH水平较高,两组间不孕年限无统计学差别;C组的Gn用量、HCG日E2水平、内膜厚度及各径线卵泡数均低于D组,差异有统计学意义;两组相比,C组抽吸的卵泡数、获卵数、移植胚胎数均较少,获卵率较低,周期取消率较高,差异有统计学意义;但C、D两组间正常受精率、卵裂率、优质胚胎率、胚胎种植率、移植周期的临床妊娠率比较差异均无统计学意义。结论:对于卵巢储备降低的卵巢低反应患者,自然周期IVF与超促排卵IVF各有利弊,可综合患者各方面条件,灵活选择治疗方案。

Objective：To explore the clinical application values of natural cycle in vitro fertilization-embryo transfer（NC-IVF-ET） and controlled ovarian hyperstimulation IVF-ET（COH-IVF-ET） in the patients with ovarian low reserve and low response. Methods：A total of 170 patients with ovarian low reserve and low response（249 cycles） who received IVF treatment from June 2007 to December 2010 were analyzed retrospectively,then they were divided into group A（NC-IVF-ET group）（87 cycles） and group B（COH-IVF-ET group）（162 cycles） according to treatment protocols;24 patients（66 cycles） were treated with two protocols successively,and they were divided into group C（NC-IVF group）（36 cycles） and group D（COH-IVF group）（30 cycles）.SPSS 13.0 software was used to analyze the general conditions,therapeutic conditions,and outcomes,a comparative analysis was conducted. Results：The age of patients in group A was younger than that of patients in group B,the number of antral follicles in group A was less than that in group B,the level of basic follicle-stimulating hormone（FSH） in group A was higher than that in group B,but there was no significant difference in the duration time of infertility between group A and group B.The dose of gonadotropin,the level of estradiol on the day of human chorionic gonadotropin（HCG） injection,the thickness of endometrium,and the numbers of follicles on different radial lines in group A were lower than those in group B;compared with group B,the numbers of follicular aspiration,retrieved oocytes,and transferred embryos were less,the rate of retrieved oocytes was lower,the cycle cancellation rate was higher,there was significant difference;there was no significant difference in the normal fertilization rate,cleavage rate,high-quality embryo rate,implantation rate of embryos,the clinical pregnancy rate,and early natural abortion rate between the two groups.The age of patients in group C was younger than that of patients in group D,the level of basic FSH in group C was higher than that in group D;but there was no significant difference in the duration time of infertility between group C and group D.The dose of gonadotropin,the level of estradiol on the day of HCG injection,the thickness of endometrium,and the numbers of follicles on different radial lines in group C were lower than those in group D,there was significant difference;compared with group D,the numbers of follicles,retrieved oocytes,and transferred embryos were less,the rate of retrieved oocytes was lower,the cycle cancellation rate was higher,there was significant difference;but there was no significant difference in the normal fertilization rate,cleavage rate,high-quality embryo rate,implantation rate of embryos,the clinical pregnancy rate,and early natural abortion rate between the two groups. Conclusion：For the patients with ovarian low reserve and low response,NC-IVF-ET and COH-IVF-ET have their advantages and disadvantages,the treatment protocol should be chosen flexibly according to the general conditions of the patients.