克罗米芬加HMG方案在POR中的应用

Clinical analysis of the controlled ovarian hyperstimulation protocol using clomiphene and HMG in poor ovarian responders

目的探讨克罗米芬加HMG方案(CC+HMG)在卵巢低反应(poor ovarian response,POR)患者IVF/ICSI-ET周期中应用优势。方法回顾性分析IVF/ICSI—ET治疗的716个卵巢低反应周期的临床资料,按促排卵方案分为四组:CC+HMG组、长方案组、短方案组、拮抗剂组。分别统计并比较各组患者的一般情况、治疗结局及总医疗费用的差异。结果 1 CC+HMG组Gn使用量最少,与其余三组比较差异有统计学意义(P<0.05);2 CC+HMG组方案获卵数较其他方案少,周期取消率高,差异有统计学意义(P<0.05);3 CC+HMG组及长方案组较其他两组的周期累积胚胎种植率高,差异有统计学意义(P<0.05);4 CC+HMG组所需的医疗费用最低,短方案组和拮抗剂组费用接近居中,长方案最高,三者之间差异有统计学意义(P<0.05)。结论对于POR患者CC+HMG方案周期费用低,累计种植率高,而累积妊娠率和累积活产率不低于其他方案的优势,是POR患者经济实用的选择。

Objective To evaluate the superiority of the controlled ovarian hyperstimulation （COH） protocol using CCand HMG in poor ovarian responders. Methods Data of 716 poor ovarian responders receiving in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI） for the assisted reproduction in our hospital from Jan.2009 to Jul.2013 was analyzed retrospectively. Patients were divided into four groups according todifferent protocals： CC＋HMG protocol group （n = 145）, long protocol group （n = 100）, short protocol group （n = 140）, gonadotrophin releasing hormone （GnRH） antagonist protocol group （n = 331）. Parameters of general datum （age, the infertility duration, BMI, Infertility reasons）, outcome of assisted conception and the medical total cost were compared among the four groups. Results （1） The dose of gonadotropin was significant lower in CC＋HMG protocol group （P 〈 0.05）. （2） OCCs numbers of retrival in CC＋HMG protocol group were significantly less than the other groups and the cycle cancellation rate in this protocol group was significantly higher than the other groups （P 〈 0.05 ）. （3） The accumulated implantation rate was significant higher in CC＋HMG protocol group and long protocol group （P 〈 0.05）. （4） The total cost of long protocol group was the highest, and that of short protocol group and GnRH antagonist protocol group were the second, the CC＋HMG protocol group had the lowest cost. There were significant differences （P 〈 0.05）. Conclusion The CC＋HMG protocol may be an ideal program for patients with poor ovarian response.