反复体外受精-胚胎移植治疗失败患者采用微刺激方案妊娠结局

Pregnancy outcome of patients received minimal stimulation after repeated IVF-ET failure

目的探讨接受常规超促排卵体外受精(IVF)≥2周期失败,年龄≤38岁的患者,采用克罗米芬微刺激周期治疗的临床结局。方法既往治疗周期表现为卵巢反应低下71周期(A组),优质胚胎率低下98周期(B组)。将月经第3天窦卵泡直径<8 mm,雌二醇(E_2)<280 pmol/L的患者,从第3天开始口服克罗米芬50 mg/d至取卵口,第8天B超监测,酌情增加人绝经期促性腺激素(HMG)注射。两组均在优势卵泡直径>15 mm,平均每个优势卵泡E_2≈1,100 pmol/L时,于当天20:30促性腺激素释放激素激动剂(GnRH-a)肌注0.2 mg诱发排卵,34～36 h后采卵;在内膜厚度达8～14mm时行胚胎移植;否则实行胚胎的玻璃化冷冻,待以后进行自然周期移植。结果 A组,优质胚胎率62.48%、临床妊娠率28.57%、每取卵周期临床妊娠率14.08%;B组分别为73.39%、45.90%及28.58%。两组优质胚胎率、妊娠率、流产率(A、B两组分别为20.08%和34.58%)无统计学差异。结论对于多次使用常规超促排卵治疗失败的患者,使用微刺激方案是比较好的选择。

Objective： To analyze pregnancy outcome of the patients less than 38 years old and received minimal stimulation after failure of regular IVF-ET more than two times. Methods： The data Of seventy one cycles of poor-response and 98 cycles of low high-quality embryo were analyzed retrospectively. The clinical parameters analyzed were mean ovum number, high-quality em- bryo rate, pregnancy rate and abortion rate. The patients with antral follicle diameter more than 8 mm and estradial levels less than 280 pmol/L on day 3 were treated clomiphene citrate 50 mg daily from day 3 to the ovum pick-up day. They received B-ultrasound examination on day 8 and hMG injection if necessary. When the follicular diameter was more than 15 mm and estradial was about 1100 pmol/L, the patients received 0.2 mg diphereline injection at 20： 30, The ovum pick-up was performed after 34-36 hours and embryo transfer was followed when the endometrial thickness reached 8-14 ram, otherwise the embryos were vitrificated. Results. In 71 cycles of poor-response, high-quality embryo rate was 62.48~, clinical pregnancy rate 28.57%, and clinical pregnancy rate of per ovum pick-up 14.08%. In 98 cycles of low high-quality embryo, high-quality embryo rate was 73.39%, clinical pregnancy rate 45.90%, and clinical pregnancy rate of per ovum pick-up 28. 58%. There were no statistical differences in the high-quality embryo rate,pregnancy rate and abortion rate of the groups. Conclusions. Minimal stimulation is the better choice for the patients of repeated IVF-ET failure.