麒麟丸对卵巢储备功能减退患者体外受精-胚胎移植的影响

Effect of Qi Lin Wan applied to patients with diminished ovarian reserve treated by in vitro fertilization and embryo transfer

目的探讨麒麟丸对卵巢储备功能减退（diminished ovarian reserve，DOR）患者体外受精一胚胎移植（in vitro fertilization and embryo transfer，IVF-ET）效果的影响。方法选取2013年1月至2015年3月在第二军医大学附属长征医院生殖医学中心就诊，拟行IvF或卵母细胞内单精子显微注射（intracytoplasmic sperm injecfion，ICSI）助孕的DOR患者共120例。将患者随机分为中药组及对照组，每组各60例。对照组患者月经第3天起给予常规温和刺激方案；中药组患者于周期前KI服麒麟丸共2个月，进入周期后在常规温和刺激方案的基础上，继续加服麒麟丸直至扳机日。所有患者均行替代周期冻胚移植。记录患者的年龄、不孕年限、基础卵泡刺激素（follicle stimulating hormone，FSH）和雌二醇水平、基础窦卵泡计数（antral follicle count，AFC）、促性腺激素（gonadotropin，Gn）用量、超促排卵天数、获卵数、胚胎数及妊娠率等指标。采用，检验和配对f检验进行统计学分析。结果120例患者的平均年龄为（38．5±2．3）岁；不孕年限1～20年；原发性不孕52例，继发性不孕68例。中药组患者的基础FSH水平低于对照组[（9．2±3．2）与（11．0±3．4）U／L，t=2．034]，AFC高于对照组[（7．4±2．7）与（6．1±2．1）个，t=-2．001]，差异有统计学意义（P值均〈0．05o虽然2组超促排卵天数和Gn用量比较差异无统计学意义（P值均〉O．05），但中药组的平均获卵数高于对照组[（4．4±2．2）与（3．3±2．2）个，t=2．132]，妊娠率也高于对照组[53_3％（32／60）与46．7％（28／60），X^2=2．819]，差异均有统计学意义（P值均〈0．05）。结论麒麟丸辅助治疗可改善DOR患者的卵巢储备功能，提高卵巢反应性，改善IVF-ET治疗结局。

Objective To discuss the effect of Qi Lin Wan applied to patients treated by in vitro fertilization and embryo transfer （IVF-ET） with diminished ovarian reserve （DOR）. Methods From January 2013 to March 2015, 120 patients with DOR who were going to receive in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI） were enrolled in Center for Reproductive Medicine, Shanghai Changzheng Hospital, Second Military Medical University. Patients were randomly divided into traditional Chinese medicine group and control group, 60 cases in each group. On the third day of menstrual cycle, the patients in control group were given routine mild stimulation. The patients in traditional Chinese medicine group took Qi Lin Wan orally for 2 months before menstrual cycle, and continued to take Qi Lin Wan after entering cycle and received the routine mild stimulation until the trigger. All patients received frozen-thawed embryo transfer of replacement cycle. The age, years of infertility, basal level of follicle stimulating hormone （FSH） and estradiol, antral follicle count （AFC）, dose of gonadotropin （Gn）, days of super ovulation, number of retrieved oocytes, number of embryos and rate of pregnancy in the two groups were analyzed. The Chi- square test and paired t test were used for statistical analysis. Results The average age of 120 patients was （38.5 ± 2.3） years, years of infertility were 1-20 years. 52 cases were primary infertility and 68 cases were secondary infertility. The basal level of FSH in traditional Chinese medicine group was lower than that in control group [ （9.2 ± 3.2） vs （11.0 ± 3.4） U/L, t =2.034, P〈0.05 ] , and AFC were higher than those in control group [ （7.4 ± 2.7） vs （6.1± 2.1）, t =2.001, P〈0.05 ] . Although there were no statistical differences in days of super ovulation and dose of Gn （P〉0.05）, the number of retrieved oocytes in traditional Chinese medicine group was higher than that in control group [ （4.4 ± 2.2） vs （3.3 ± 2.2）, t =2.132, P〈0.05）. So was the rate of pregnancy [ 53.3% （32/60） vs 46.7% （28/60）, X^2=2.819, P〈0.05） ] . Conclusion The adjuvant therapy of Qi Lin Wan can improve the ovarian reserve function of DOR patients, improve ovarian response and the outcomes of IVF-ET treatment.