益经汤联合高孕激素状态下促排卵方案在高龄女性体外受精-胚胎移植中的应用

Application of Yijing Decoction combined with PPOS program in IVF-ET for elderly women

目的:探讨益经汤联合高孕激素状态下促排卵(PPOS)方案在体外受精(IVF)/胚胎移植(ET)过程中对高龄卵巢低反应(POR)患者的应用价值。方法:随机将行IVF-ET助孕的高龄POR患者分为两组:PPOS方案(A)组、益经汤预处理+PPOS(B)组,每组33例。比较两组患者促排卵过程中激素水平、药物使用情况、获卵及实验室结局等。进一步检测各组卵泡液中抗氧化基因丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)的活性和颗粒细胞CYP17、CYP19 mRNA表达差异。结果:B组用药后较用药前FSH显著降低(P<0.05),AMH、AFC显著升高(P<0.05)。与A组比较,B组MⅡ卵数、2PN数、优胚数(率)均显著升高(P<0.05)。B组卵泡液中MDA、SOD、GSH-Px水平,颗粒细胞CYP17、CYP19 mRNA表达均显著高于A组(P<0.05)。结论:益经汤联合PPOS方案,能增加获卵数、成熟卵和优胚数,进而改善高龄患者IVF促排卵结局。可能与其促卵巢抗氧化基因表达,上调CYP17、CYP19表达,增加雌激素分泌,改善卵母细胞质量有关。

Objective:To investigate the application value of Yijing Decoction combined with progestin primed ovarian stimulation(PPOS)in elderly patients with poor ovarian reaction(POR)during in vitro fertilization and embryo transfer(IVFET).Methods:The elderly POR patients who underwent IVF-ET were randomly divided into two groups:PPOS regimen(A)group,Yijing Decoction+PPOS(B)group,33 cases in each group.Hormone levels,drug use,the number of retrieval oocytes and laboratory outcomes were compared between the two groups.Further detection of the activities of the antioxidant genes malondialdehyde(MDA),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and the expression of CYP17 and CYP19 mRNA in granulosa cells.Results:After treatment,the FSH of group B was significantly lower than that of pretreatment(P<0.05),AMH and AFC were significantly increased(P<0.05).Compared with group A,the number of MⅡeggs,2 PN number and number of high-quality embryos in group B were significantly increased(P<0.05).The levels of MDA,SOD and GSH-Px in the follicular fluid of group B and the mRNA expression of CYP17,CYP19 in the granulosa cells were significantly higher than those of group A(P<0.05).Conclusion:Yijing Decoction combined with PPOS can increase the number of eggs,mature eggs and high-quality embryos,and improve the IVF ovulation induction in elderly patients.It may promote ovarian antioxidant gene expression,up-regulate CYP17,CYP19,increase estrogen secretion,and improve oocyte quality.