不同促排卵方案在多囊卵巢综合征患者IVF-ET中的应用

Application on mini-stimulation protocol of letrozole in the patients with polycystic ovary syndrome for in vitro fertilization and embryo transfer

目的:探讨三种促排卵方案在多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)周期的临床应用比较。方法:PCOS患者根据用药情况分为传统长效促性腺激素释放激素激动剂(GnRHa)长方案A组20周期、短效GnRH-a长方案B组26周期和来曲唑微刺激方案C组22周期,比较三组患者的促排卵参数和临床结局。结果:1A组Gn使用天数及用量、HCG注射日血清E2高于B、C组,临床妊娠率低于B、C组(P<0.05);A组HCG注射日血清LH、正常受精率、卵裂率、优质胚胎率低于C组,获卵数、OHSS发生率高于C组(P<0.05),但在与B组组间比较,差异均无统计学意义(P>0.05);A组HCG日血清P、子宫内膜厚度、周期取消率和冷冻胚胎数与B、C组组间比较,差异无统计学意义(P>0.05)。2B组Gn用量、HCG日血清E2、获卵数、OHSS发生率高于C组、HCG日血清LH、P、正常受精率、临床妊娠率低于C组(P<0.05);B组Gn天数、HCG日子宫内膜厚度、卵裂率、优质胚胎率、周期取消率和冷冻胚胎数与C组组间比较,差异无统计学意义(P>0.05)。结论:来曲唑微刺激方案临床效果优于长效与短效GnRHa长方案,同时降低Gn使用总量,减轻患者单周期治疗费用,是PCOS患者较理想的促排卵方案。

Objective To explore the application of mini-stimulation protocol of letrozole in in vitro fertilization and embryo transfer（IVF-ET） among patients with polycystic ovary syndrome. Method 68 cycles of the patients with polycystic ovary syndrome receiving IVF were divided into three groups according to using long-acting（ n = 20） or short-acting（ n = 26） gonadotropin releasing hormone agonist（ GnRHa） and mini-stimulation of letrozole（ n = 22）. The parameters during treatment cycles were compared between the three groups. Results ①The stimulation days and dose of gonadotropic hormone and the serum estradiol level on the day of human chorionic gonadotropin（ HCG） injection in group A were significantly higher than those in group B and C,clinical pregnancy rate was lower than other two groups（ P 〈0. 05）. The serum level of luteinizing hormone on the day of HCG injection,fertilization rate,cleavage rate,high quality embryo rate in group A were lower than those in group C,but average numbers of retrieved oocytes,occurrence rate of ovarian hypertimulation syndrome（ OHSS） were higher than those in group C（ P 〈0. 05）. These targets was no significant difference between A and B groups（ P 〉0. 05）. The serum level of progesterone on the day of HCG injection,the depth of endometrium,the number of cancel transfer and frozen-thawed embryo were no significant difference between three groups（ P〉 0. 05）. ②The dose of gonadotropic hormone,the serum estradiol level on the day of HCG injection,average numbers of retrieved oocytes,occurrence rate of OHSS were higher than those in group C. The serum level of luteinizing hormone and progesterone on the day of HCG injection,fertilization rate,clinical pregnancy rate were lower those in group C（ P 〈0. 05）; There was no significant difference in other targets between two groups（ P 〉0. 05）. Conclusion Mini-stimulation protocol of letrozole can obtain better clinical efficacy than GnRHa protocol during IVF ovulation cycle for the patients with polycystic ovary syndrome,meanwhile,it can reduce the total administration dose of gonadotropic hormone and the treatment cost.