高孕激素状态下促排卵方案(PPOS)与非典型微刺激方案在卵巢低反应患者体外受精-胚胎移植(IVF-ET)中的效果

Analysis of progestin-primed ovarian stimulation and atypical mild stimulation during IVF treatment in poor ovarian response women

目的:探讨高孕激素状态下促排卵(PPOS)方案与非典型微刺激方案在卵巢低反应(POR)患者体外受精-胚胎移植(IVF-ET)中的应用效果。方法:回顾性分析行IVF助孕的POR患者共522个IVF周期。根据促排卵方案不同分为两组:A组(非典型微刺激组,n=239)和B组(PPOS组,n=283),比较A、B组患者的基础情况、临床促排卵过程的内分泌特点、卵泡及胚胎发育情况等。结果:A、B组患者的一般情况具有可比性,A组的h MG使用总量、h MG使用天数、卵泡输出率、可移植胚胎数、冻融胚胎移植周期率低于B组,差异有统计学意义(P<0.05),A组的h CG注射前日LH水平、h CG注射日LH水平、早发LH峰率、周期取消率高于B组,差异有统计学意义(P<0.05),其余指标组间差异无统计学意义(P>0.05)。结论:PPOS方案可以改善卵巢的反应性,有效抑制早发LH峰,增加可移植胚胎数,降低周期取消率,是一种适合低反应患者的临床促排卵方案。

Objective： To analyze the outcomes of progestin-primed ovarian stimulation （PPOS） and mild stimulation during in vitro fertilization treatment （IVF） in poor ovarian response （POR） women. Methods： The data of 522 POR women with IVF treatment were collected retrospectively. Patients were divided into two groups： group A （mild stimulation group, n=239） and group B （PPOS group, n=283）. The general characteristics and outcomes were compared between the two groups. Results： The general characteristics were not significant different between the two groups. The total dosage of human menopause gonadotropin （hMG）, duration of hMG used, follicular output rate, number of available embryos, all embryos freezing rate were much lower in group A than in group B （P〈0.05）, while the LH levels of the day of human chorionic gonadotropin （hCG） and before the day of hCG injection, premature LH surge, and cancellation rate were much higher in group A than in group B （P〈0.05）. No statistically significant differences were found in the rest indicators. Conclusion： PPOS protocol could improve ovarian response, control premature LH surge, increase available embryos and reduce the cycle cancellation rate. PPOS protocol might be preferable for advanced and POR women.