益气血填肾精分段法在卵巢低反应患者预处理中的助孕作用

Proconceptive effect of segmentation method of replenishing Qi and blood and enriching kidney essence in patients with poor ovarian response

目的探讨益气血填肾精分段法对辅助生殖中卵巢低反应(POR)患者预处理的助孕作用。方法选取2014年12月-2016年10月在该院生殖中心就诊的102例卵巢低反应患者,采用随机的方法分为治疗组50例,对照组52例。治疗组予以益气血填肾精分段法治疗,对照组不服药;12周后两组再次以拮抗剂方案超促排卵。分别在治疗0、4、8、12周测两组患者血清卵泡刺激素(FSH)、抗缪勒氏管激素(AMH)、窦卵泡计数(AFC);于h CG日测血雌二醇(E2)、子宫内膜厚度、≥18 mm的卵泡数;超促排后比较促性腺激素(Gn)总剂量、获卵数、受精数、卵裂数、优质胚胎数、新鲜胚胎移植数和冷冻胚胎数。结果 (1)两组AFC比较:治疗组用药4、8、12周都较治疗前升高(P<0.05);治疗组用药4、8、12周与对照组相比都有上升趋势,但差异无统计学意义(P>0.05)。(2)两组FSH比较:治疗组用药4、8、12周都较治疗前下降(P<0.05);治疗组用药8周与对照组相比下降(P<0.05),治疗组用药4周、12周与对照组相比呈下降趋势,但差异无统计学意义(P>0.05)。(3)两组AMH比较:治疗组用药12周后较治疗前升高(P<0.05);治疗组用药12周与对照组相比升高,差异有统计学意义(P<0.05)。(4)两组用药前后临床疗效比较:两组用药12周后再次拮抗剂超促排卵发现,治疗组较对照组在Gn用药总量有降低趋势,Gn用药时间有减少趋势,h CG日≥18mm卵泡数有增加趋势,获卵数、受精卵数、卵裂胚胎数、鲜胚移植数都有增加趋势,但以上差异都无统计学意义(P>0.05);而治疗组的子宫内膜厚度较对照组显著增加(P<0.05),优质胚胎数显著增加(P<0.05)。结论益气血填肾精分段法对辅助生殖中POR患者预处理,可以改善患者卵巢功能,提高卵巢反应性,增加子宫内膜厚度、提高优质胚胎数。

Objective To explore the proconceptive effect of segmentation method of replenishing Qi and blood and enriching kidney essence in patients with poor ovarian response （POR） . Methods A total of 102 patients with POR were selected from Reproductive Center of the hospital from December 2014 to October 2016, then they were randomly divided into treatment group （50 patients） and control group （52 patients） . The patients in treatment group were treated by segmentation method of replenishing Qi and blood and enriching kidney es- sence, while the patients in control group were not treated by any therapy. After 12 weeks, tile patients in the two groups underwent ovarian hyperstimulation with antagonists treatment again. The levels of serum follicle stimulating hormone （FSH）, anti- Mtillerian hormone （AMH）, antral follicle count （AFC） after 0, 4, 8, 12 weeks in the two groups were detected respectively. The levels of blood estradiol, endometrial thickness, and the number of follicles with diamter≥ 18 mm on the day of human chorionic gonadotropin （hCG） injection were detected. After ovarian hyperstimulation, the total doses of gonadotropin （Gn） and the numbers of retrieved oocytes, fertilization, cleavage, high-quality embryos, fresh embryo transfer and frozen embryos were compared. Results Compared with before treatment, AFC ＇after 4, 8, 12 weeks in the two groups increased significantly （P〈0. 05 ） . Compared with control group, AFC ＇after 4, 8, 12 weeks in treatment group increased, but there was no statistically significant difference （P〉0. 05 ） . Compared with betbre treatment, FSH levels after 4, 8, 12 weeks in treatment group decreased significantly （ P〈0. 05 ） . Compared with control group, FSH level after 8 weeks in treatment group decreased significantly （P〈0. 05 ） . Compared with control group, FSH levels ＇after 4 and 12 weeks in treatment group decreased, but there was no sta- tistically significant difference （P〉0. 05 ） . Compared with before treatment, AMH level after 12 weeks in treatment group increased signifi- cantly （P〈0. 05 ） . Compared with control group, AMH level after 12 weeks in treatment group increased significantly （P〈0. 05 ） . After 12 weeks, compared with control group, the total dose of Gn in treatment group decreased, the application time of Gn decreased, the number of follicles with diameter≥ 18 mm on the day of hCG injection increased, the numbers of retrieved oocytes, fertilization, cleavage, fresh em- bryo transfer increased, but there was no statistically significant difference in the above-mentioned indexes between the two groups （P〉 0. 05 ） ; endometrial thickness in treatment group was statistically significantly thicker than that in control group （ P〈0. 05 ） , the number of high-quality embryos increased significantly （P〈0. 05） . Conclusion Pretreatment of POR patients in assisted reproduction by segmef, ta- tion method of replenishing Qi and blood and enriching kidney essence can improve ovarian function and ovarian response, increase endome-trial thickness and the number of high-quality embryos.