疏肝补肾法辅助治疗对卵巢储备功能不良患者IVF-ET周期低反应的研究

Smoothing Gan Reinforcing Shen Method Adjuvantly Treated Poor Response of Diminished Ovarian Reserve Patients in in vitro Fertilization and Embryo Transfer:a Clinical Study

目的研究疏肝补肾法辅助治疗在卵巢储备功能不良(diminished ovarian reserve,DOR)患者体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)周期低反应中应用的临床疗效。方法将接受IVF-ET治疗的84例DOR患者按随机数字表法分为中药辅助治疗组和对照组,每组42例。对照组采用控制性超促排卵治疗,并进行IVF-ET。中药辅助治疗组在对照组治疗基础上给予疏肝补肾法的基础方,每日1剂。促排卵过程中记录基因重组人促卵泡素(recombinant follicle-stimulating hormone,r-FSH)使用时间及用量,化学发光法测定人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射日、取卵日血清雌二醇(estradiol,E_2);ELISA法检测取卵日卵泡液E_2含量。记录IVF-ET过程中获卵数、成熟卵数(metaphaseⅡ,MⅡ)、正常受精数(two pronucleus,2PN)、可移植胚胎数及优质胚胎数。观察中药辅助治疗与上述指标之间的相关性。比较两组患者临床妊娠率及流产率。结果 r-FSH用量、HCG注射目E_2水平、取卵日血清E_2水平、获卵数、MⅡ卵数、2PN数、可移植胚胎数及优质胚胎数均与中药辅助治疗存在显著正相关关系(P<0.05,P<0.01);与对照组比较,中药辅助治疗组HCG注射日及取卵日血清E_2明显升高,获卵数、MⅡ卵数及可移植胚胎数亦多于对照组,差异有统计学意义(P<0.05,P<0.01)。两组临床妊娠率及流产率比较,差异无统计学意义(P>0.05)。结论疏肝补肾法中药辅助治疗可改善DOR患者IVF-ET治疗卵巢反应性,增加获卵数,提高卵子质量、胚胎数。

Objective To study clinical efficacy of smoothing Gan reinforcing Shen（SGRS）method in treating poor response of diminished ovarian reserve（DOR） patients in in vitro fertilization and embryo transfer（IVF-ET）.Methods Totally 84 DOR patients undergoing IVF-ET were assigned to the experimental group（SGRS Chinese herbs as adjuvant therapy） and the control group according to random digit table,42 in each group.Patients in the control group received controlled ovarian hyperstimulation（COH） and IVF-ET.Those in the experimental group additionally received basic formula of SGRS method,one dose per day.The dose and use time of recombinant follicle-stimulating hormone（r-FSH） were recorded during ovarian stimulation process.On the injection day of human chorionic gonadotropin（HCG）and serum levels of estradiol（E_2） on the oocyte retrieval day were determined using chemiluminescent method.E_2 contents in the follicular fluid on the oocyte retrieval day were detected using ELISA.The total number of retrieved oocytes,the number of mature oocytes in metaphase Ⅱ（MⅡ）,the number of normal fertilization[with two pronucleus（2PN）],the number of portable embryos,and the number of good quality embryos were recorded.The correlation between Chinese medical adjuvant therapy and the aforesaid indices were observed.The clinical pregnancy rate and the abortion rate were finally compared between the two groups.Results The total dose of r-FSH,the E_2 level on HCG injection day,the serum E_2level on the oocyte retrieval day,the number of retrieved oocyte,the number of oocytes in MA the number of oocytes with 2PN,the number of portable embryos,and the number of good quality embryos were all positively correlated with Chinese medical adjuvant therapy（P 0.05,P 0.01）.Compared with the control group,serum E_2 levels on the HCG injection day and the oocyte retrieval day obviously increased,the number of retrieved oocytes,the number of oocytes in M Ⅱ,and the number of portable embryos were increased more in the experimental group with statistical difference（P〈0.05,P〈0.01）.There was no statistical significance in the clinical pregnancy rate or the abortion rate between the two groups（P〉 0.05）.Conclusion SGRS Chinese herbs as adjuvant therapy could improve ovarian responsiveness of DOR patients undergoing IVF-ET,increase the number of retrieved oocytes,elevate the quality of oocytes and the number of embryos.