卵巢功能正常患者高孕激素状态下促排卵的内分泌特征及IVF/ICSI临床结局的研究

Endocrine characteristic and the clinical outcomes of IVF/ICSI treatment in women with normal ovarian reserve during progestin-primed ovarian stimulation

目的:探讨高孕激素状态下促排卵方案在临床应用中的价值。方法:将因输卵管因素或男方因素或不明原因行IVF/ICSI治疗的不孕症患者分成高孕激素状态下促排卵组(A组,n=57)和短方案组(B组,n=59),观察患者的获卵数、成熟卵数、正常受精数、卵裂数、有效胚胎数及促排卵过程中血清FSH、LH、E2、P、抑制素A和B的水平及后续冻融胚胎移植(FET)周期的妊娠结局。结果:高孕激素促排卵组患者的获卵数10.8±5.4个,与短方案组相比无统计学差异(P>0.05),获卵数、成熟卵数、受精数、卵裂数,有效胚胎数与短方案组相似(P>0.05),后续的FET周期中,临床妊娠率和胚胎种植率比短方案组稍高(47.9%,42.1%vs 40.9%,31.9%),但均无统计学差异(P>0.05)。高孕激素促排卵过程中LH水平逐渐下降,诱发排卵日的LH水平在1.3±0.9 IU/L,无一例发生自发LH峰。结论:高孕激素状态下促排卵组可以获得具有发育潜能的胚胎,还可以有效控制早发LH峰。高孕激素状态下促排卵方案可作为一种新的促排卵方案应用于临床实践,但是其广泛推广应用还有待多中心的联合研究。

Objective： To analyze the endocrine characteristics and the clinical outcomes of IVF/ICSI treatment during progestin-primed ovarian stimulation, and to explore the value of clinical application of progestinprimed ovarian stimulation. Methods： A prospective study including 116 patients with normal ovarian reserve was performed, the patients were divided into two groups. In group A（n=57）, h MG and medroxyprogesterone acetate（MPA） were administered simultaneously beginning on menstrual cycle day 3/4, that is progestinprimed ovarian stimulation. In group B（n=59）, the short protocol was performed. The levels of FSH, LH, E2,P, inhibin A and inhibin B were measured during the ovarian stimulation to investigate the endocrine characteristic of progestin-primed ovarian stimulation. The number of oocytes retrieved, the number of mature oocytes, the number of fertilization and the number of cleavage, the clinical pregnancy rates and the implantation rates in the subsequent FET cycles were compared between the two groups. Results： The number of oocytes retrieved in group A was similar to group B（P〉0.05）. No differences were found in the number of mature oocytes,the number of fertilization and the number of cleavage between the two groups. No statistically significant differences were found in the clinical pregnancy rates and the implantation rates in frozen-thawed embryo transfer（FET） cycles. LH values gradually decreased during progestin-primed ovarian stimulation and no patients experienced premature LH surge. Conclusion： The embryos originating from the progestin-primed ovarian stimulation have a similar developmental potential compared with the control. Progestin-primed ovarian stimulation provides an effective method to control premature LH surge during the ovarian stimulation. Progestin-primed ovarian stimulation can be used as a new kind of ovarian stimulation scheme applied in clinical practice to control premature LH surge during the ovarian stimulation, but its widespread application has yet to need more centers join this research.