卵巢储备功能下降患者应用双刺激方案、微刺激方案、黄体期促排方案的妊娠结局比较

Comparison of pregnancy outcome among double stimulations,mild stimulation and lutea-phase stimulation protocol in patients with diminished ovarian reserve

目的探讨双刺激方案、微刺激方案以及黄体期促排方案在卵巢储备功能下降(DOR)患者IVF-ET中的临床疗效。方法回顾性分析接受IVF-ET或ICSI-ET助孕的791例周期DOR患者临床资料,根据促排方案的不同分为双刺激方案组(A组,n=395)、微刺激方案组(B组,n=302)和黄体期促排方案组(C组,n=94)。比较各组患者的临床资料、促排卵效果及妊娠结局。结果三组患者间年龄、不孕年限、基础FSH、LH、E_2、胚胎种植率、临床妊娠率等均无显著性差异(P>0.05);A组两期促排后其促排天数、Gn用量、获卵数、可移植胚胎数、优质胚胎数及活产率,与B、C组比较均显著增加(P<0.05),而周期取消率显著降低(P<0.05)。结论双刺激方案可缩短IVF-ET的治疗时间,增加患者一个月经周期内的获卵数、可移植胚胎数、优质胚胎数,但Gn用量和促排天数也相应增加,对于促排后获卵困难的卵巢储备功能下降显著的患者有一定临床意义。

Objective：To investigate the clinical efficacy of double stimulations,mild ovarian stimulation and lutea-phase ovarian stimulation protocol in IVF-ET cycle of patients with diminished ovarian reserve（DOR）Methods：The data of 791IVF-ET or ICSI-ET cycles in DOR patients were retrospectively analyzed.The cycles were divided into three groups according to the different protocol of controlled ovary hyperstimulation（COH）：double stimulations protocol in group A（n=395）,mild ovarian stimulation in group B（n=302）,and lutea-phase ovarian stimulation in group C（n=94）.The clinical data,the efficacy of ovulation induction and the pregnancy outcomes were compared among the groups.Results：There was no statistical difference in age,duration of infertility,the basic levels of FSH,LH and E2,implantation rate,and the clinical pregnancy rate among the three groups.After two sequential ovarian stimulation cycle,the total dose and days of gonadotropin used,the number of oocytes retrieval,available embryos and high-quality embryos in group A were significantly higher but the cycle cancellation rate was significantly lower than those in the group B or group C（all P〈0.05）.Conclusions：The double stimulations protocol can shorten the IVF-ET treatment time,and improve the number of oocytes retrieval,available embryos and high-quality embryos,but increase the doses and days of gonadotropin used.There is a clinical significance for patients with significant ovarian reserve dysfunction.