拮抗剂方案与克罗米芬微刺激方案对卵巢低反应患者体外受精胚胎移植结局的临床研究

Clinical Study on the Antagonist Regimen and Clomiphene Micro Stimulus Regimen on the Outcome of Patients with Poor Ovarian Response in Vitro Fertilization and Embryo Transplantation

目的:探讨拮抗剂方案与克罗米芬微刺激方案在卵巢低反应(POR)患者控制性超促排卵(COH)周期中的临床效果。方法:通过对151例POR患者行体外受精-胚胎移植(IVF-ET)周期进行回顾性分析,比较拮抗剂方案102个周期(A组)和微刺激方案49个周期(B组)的临床资料和助孕结局。结果:A组促性腺激素药物(Gn)用量、Gn天数、人绒毛膜促性腺激素(hCG)注射日血清雌二醇(E_2)、内膜厚度、获卵数、可利用胚胎数、优质胚胎数、均高于B组,比较差异均有统计学意义(P<0.05);A组h CG注射日血清黄体生成素(LH)值、周期取消率低于B组,比较差异有统计学意义(P<0.05);两组优质胚胎率、新鲜胚胎移植临床妊娠率和新鲜周期全胚冷冻后行解冻胚胎移植妊娠率比较差异均无统计学意义(P>0.05)。结论:在POR患者促排治疗中,克罗米芬微刺激方案与拮抗剂方案相比有相近的临床结局。因此当拮抗剂方案使用受到客观限制时,克罗米芬微刺激方案可作为一种较好的替代方案。但无论哪种方案均建议取消取消新鲜周期胚胎移植,行冻融胚胎解冻移植。

Objective：To investigate clinical effect of antagonist regimen and Clomiphene micro stimulus regimen with poor ovarian response（POR） patients with controlled ovarian hyperstimulation ovulation（COH） cycle.Method：The 151 POR patients cycles of vitro fertilization and embryo transfer（IVF-ET） were retrospectively analyzed,the clinical data and pregnancy outcomes of antagonist regimen 102 cycles（group A）and Clomiphene micro stimulus regimen 49 cycles were compared.Result：The dosage of gonadotropin drugs（Gn）,Gn days,human chorionic gonadotropin（hCG） injection day of serum estradiol（E_2）,endometrial thickness,number of retrieved oocytes,the number of available embryos,high quality embryo rate in group A were higher than the group B,the differences were statistically significant（P〈0.05）.The serum luteinizing hormone（LH） in hCG injection day and cycle cancellation rate of group A was lower than the group B,the difference was statistically significant（P〈0.05）.There were no significant difference in the High quality embryo rate,clinical pregnancy rate of fresh embryo transfer and pregnancy rate of frozen thawed embryos after fresh cycle whole embryo freezing in two groups（P〈0.05）.Conclusion：In patients with POR in ovulation induction treatment,Clomiphene micro stimulus regimen compared with antagonist regimen has similar clinical outcomes.Therefore,when the use of the antagonist regimen is subject to objective constraints,Clomiphene micro stimulus regimen can be used as a good alternative.But no matter what the program is used that recommended to cancel the fresh cycle embryo transfer and use the line of frozen thawed embryo transfer.