改良超长方案在卵巢储备功能低下高龄患者中的应用

Use of Modified Ultra-long Protocol in Elder Women with Low Ovarian Reserve

目的：探讨改良超长方案行体外受精．胚胎移植（IVF-ET）助孕的高龄（年龄≥40岁）且卵巢储备功能低下（窦卵泡3～7个）患者的治疗结局。方法：采用随机对照前瞻研究的方法，将行ⅣF—ET的120例高龄且卵巢储备功能低下患者随机分成：改良超长方案ga（A组，n=55）和拮抗剂方案组（B组，n=65），比较A、B组间IVF—ET结局。结果：A组的Gn使用总量（3955．2±1194．3It．r）、Gn使用天数（11．7±1．9d）、hCG注射日E2水平（2452．7±1285．6pg／m1），hCG注射日子宫内膜厚度（12．1±2.3mm）均明显高于B组（分别为2022．5±610．1IU、9．1±1．7d、1257．7±696．0pg／ml、11．3±2．0mm），P〈0．05；周期取消率、优质胚胎率、妊娠率、着床率、流产率、宫外孕发生率组间均无统计学差异（胗0．05）。A组hCG注射日LH水平（1．0±0．5mlU／m1）及P／E2值（0．3±0．2）明显低于Bgg（3．4±2．4mlU／ml及0．5±0．2），P〈0．05。结论：改良超长方案经过GnRHa的预处理，使患者充分降调节，hcG注射日可以获得良好的LH水平、P／E2值及内膜厚度；而hMG的使用，既可降低患者费用，又可以适当补充LH，提高子宫内膜容受性。因此，对于高龄且卵巢储备功能低下的患者，改良超长方案是一个经济有效的治疗选择。

Objective： To compare IVF outcomes with ultra-long protocol and antagonist protocol in women of low ovarian reserve and advanced age （≥40 years old）. Methods： A total of 120 patients aging over 40 years old with low ovarian reserve undergoing IVF （total number of AFC was 3-7） were prospectively randomized into 2 groups： group A, 55 patients were down-regulated with two dosages of GnRHa （ultra-long protocol）; group B, 65 patients were subjected to flexible antagonist. All participants met the following inclusion criteria： with less than 3 cycles, with no uterine abnormalities and hydrosalpinges. Results： Gn dosage （3 955.2 ±1 194.3 IUvs2 022.5 ±610.1 IU） and duration （11.7 ±1.9 dvs 9.1 ±1.7 d）, E2 level （2 452.7 ± 1 285.6 pg/ml vs 1 257.7 ± 696.0 pg/ml） and endometrial thickness （12.1 ± 2.3 mm vs 11.3± 2.0 mm） on hCG injection day in groupA were higher than those in group B. There were no significant differences in cancellation rate, the number of high-quality embryos, pregnancy rate, implantation rate, abortion rate and pregnancy rate between the two groups. The LH level （1.0 ±0.5 mlU/ml） and P/E2 ratio （0.3± 0.2） in group A were much lower than those in group B （3.4 ±2.4 mIU/ml, 0.5 ± 0.2）. Conclusion： Abundant down- regulation with modified ultra-long GnRHa protocol results in a satisfying LH level, P/E2 ratio and endometrial thickness, hMG used in ultra-long GnRI-Ia protocol both decreases expenses and increases endometrial receptivity by supplying LH. Therefore, modified ultra-long GnRHa protocol is a cost-effective and proper choice to older women with low ovarian reserve.