益气养阴方联合体外受精-胚胎移植对卵巢低反应患者卵细胞质量及妊娠结局的影响

Effect of Yiqi Yangyin Formula on Oocyte Quality and Pregnancy Outcome in Poor Ovarian Response Patients with In Vitro Fertilization and Embryo Transfer

目的观察益气养阴方在卵巢低反应(POR)患者体外受精-胚胎移植(IVF-ET)过程中对卵细胞质量及妊娠结局的影响,并探讨其可能作用机制。方法将既往曾行体外受精(IVF)治疗并诊断为POR的59例患者随机分为治疗组28例和对照组31例。两组均采用微刺激方案,治疗组从促超排卵当月月经第2天开始至人绒毛膜促性腺激素(HCG)注射日给予益气养阴方,每日1剂。比较两组患者获卵及妊娠结局情况,观察促超排卵过程中促性腺激素(Gn)使用情况、性激素水平及子宫内膜厚度,并检测患者卵泡液颗粒细胞生长分化因子-9(GDF-9)、骨形态发生蛋白-15(BMP-15)表达。结果治疗组平均获卵数、受精率、优胚率、取卵周期临床妊娠率分别为(4.51±2.49)个、51.93%、47.19%、23.81%,对照组分别为(2.02±1.98)个、46.90%、42.42%、10.42%,治疗组获卵数、取卵周期临床妊娠率均明显高于对照组(P<0.05),受精率、优胚率两组比较差异无统计学意义(P>0.05)。与对照组比较,治疗组Gn使用量显著降低,雌二醇水平、子宫内膜厚度均显著升高,颗粒细胞GDF-9、BMP-15表达显著升高,差异均具有统计学意义(P<0.05)。结论益气养阴方可改善POR患者IVF-ET过程中的卵巢反应性,提高获卵数并增加患者妊娠率,其作用机制可能与调控卵巢颗粒GDF-9、BMP-15表达有关。

Objective To observe the effect of Yiqi Yangyin Formula on oocyte quality and pregnancy outcome in poor ovarian response（ POR） patients with in vitro fertilization and embryo transfer（ IVF-ET） and discuss the possible mechanism. Methods In total 59 POR patients with the history of IVF-ET were randomly divided into a treatment group with 28 cases and a control group with 31 cases. Both groups adopted the Minimal Stimulation IVF（ MiniIVF）,and the treatment group was also administered with Yiqi Yangyin Formula one dose daily from the second day of the menstrual cycle in the month when the control ovarian hyperstimulation started until the day when the patients were injected with human chorionic gonadotropin（ HCG）. Retrieved oocytes and pregnancy outcomes between the two groups were compared. The usage of Gn during tropic hyper ovulation,sex hormone levels and endometrial thickness in both groups were observed. Also,the expression of growth differentiation factor-9（ GDF-9） and bone morphogenetic protein-15（ BMP-15） in granulosa cell in follicle fluid from patients were detected. Results The average number of retrieved oocytes,fertilization rate,optimal embryo rate,clinical pregnancy rate in oocyte retrieval cycles were4. 51 ± 2. 49,51. 93%,47. 19% and 23. 81% in the treatment group,and 2. 02 ± 1. 98,46. 90%,42. 42%,and 10. 42% in the control group,respectively. There were significant differences in the number of retrieved oocytes and clinical pregnancy rate between the two groups（ P〈0. 05）,while no statistical differences showed in fertilization rate and optimal embryo rate between the two groups（ P〉 0. 05）. Compared with those in the control group,the usage of Gn was less,the estradiol levels,the endometrial thickness,and the expression of GDF-9 and BMP-15 were higher in the treatment group,with significant differences between the two groups（ P〈0. 05）. Conclusion Yiqi Yangyin Formula could improve the ovarian response in POR patients in the process of IVF-ET,and increase the number of retrieved oocytes and pregnancy rate. The possible mechanism might be related with regulating the expression of GDF-9 and BMP-15 in ovarian granulosa cells.