再次体外受精-胚胎移植获卵数的改变及其影响因素的分析

Change in ocyte yield in repeated in vitro fertilization cycles and analysis of related factors

目的探讨首次体外受精(IVF)-胚胎移植(ET)/卵母细胞内单精子显微注射(ICSI)失败行再次IVF/ICSI-ET时获卵数的变化以及相关影响因素的分析。方法回顾性分析222例在12个月内行2次IVF/ICSI-ET周期的患者,根据基础窦卵泡数(b AFC)将患者分为A组(b AFC≥9)和B组(b AFC<9),分析每组前后两周期间患者的基本情况、临床方案、获卵数、进入减数分裂中期II(MII期)卵子数、正常受精率、优胚率、累积妊娠率的变化,探讨影响前后周期获卵数发生变化的相关因素。结果A组第二个IVF周期(cycle2)获卵数、MII期卵子数、受精率、优胚率、累积妊娠率明显高于第一个IVF周期(cycle1),前后周期中临床方案无大的变化,均以长方案为主,但cycle2每日的促性腺激素(Gn)使用剂量高于cycle1(P<0.05)。B组中相对于cycle1,cycle2获卵数、MII期卵子数差异无统计学意义,而优胚率及累积妊娠率均提高,并且cycle2中短方案明显多于cycle1(P<0.05)。其中B组中有14例患者在cycle1中为长方案,在cycle2中转变为短方案,后者的获卵数以及MII期卵子数均高于前者(P<0.05)。结论对于卵巢功能正常的患者,结合患者cycle1中获卵数以及Gn使用剂量,在控制卵巢过度刺激综合征发生的情况下,cycle2中可通过适当的提高每日Gn使用剂量来提高获卵数及MII期卵子数。相对于长方案,短方案可能更适合卵巢功能减退的患者。

To examine the change in total and mature oocyte yield between consecutive IVF cycles and disscuss the factors that predict this change . Methods A retrospective analysis of the clinical data and outcomes was conducted among 222 women starting two IVF/ICSI cycles within 12 months. According to the bAFC, patients were divided into group A （AFC 1〉9 ）and group B （AFC 〈 9 ）. The basic condition of the patients , the change in to- tal and mature oocyte yield, fertilition rate, high quality embryo rate, the Cumulative pregnancy rate were compared between the consecutive IVF cycles in each group. Results In group A, the number of eggs, MII, fertilization rate, high quality embryo rate, the cumulative pregnancy rate in the second IVF cycle were significantly higher than that of the first cycle （ P 〈 0.05 ）. The clinical scheme had no big changes between the cycles, all with long program was given priority to. But in the second cycle, the Gn usage was higher than the previous period （P 〈 0. 05 ）. In group B, there was no significant difference in both total and mature oocytes between the cycles. Howerer, the opti- mal embryo rate, cumulative pregnancy rate and the number of short program significantly increased in the second cycle （P 〈 0.05 ）. Among group B, 14 patients used long program in the first cycle, and converted into a short pro- gram in the second cycle, which attained more eggs and MII than the former（P 〈 0. 05 ）. Conclusion An increase in total and mature oocyte yield between cycles is found in women with normal ovarian reserve and is associated with an appropriately increased in daily Gn used dose in the second cycle. Compared with the long program, the short program may be more suitable in patients with diminished ovarian reserve.