微刺激全胚胎冷冻方案在常规IVF-ET治疗失败无优质胚胎患者中的应用

Application of mild stimulation protocol in the normal responders after failure of routine IVF-ET without high quality embryos

目的探讨微刺激全胚胎冷冻方案在常规IVF-ET治疗因胚胎质量差助孕失败患者中的应用价值。方法收集在本中心行常规促排卵后IVF/ICSI-ET助孕治疗、因无优质胚胎放弃或移植失败后改用微刺激方案助孕的106例患者为研究对象,回顾性分析常规促排卵的124个周期和改行微刺激方案后的156个周期的临床资料。比较不同促排卵方案的各项参数及妊娠结局。结果微刺激组的Gn天数[(7.24±2.41)vs.(10.59±1.81)d]、Gn总量[(656.97±347.17)vs.(2 409.54±726.01)U]、HCG注射日E_2水平[(451.46±350.85)vs.(1 275.93±674.46)pmol/L],以及成熟卵母细胞数[(2.53±2.15)vs.(8.98±5.29)个]等均显著低于常规方案组(P均<0.05),但微刺激组的每卵胚胎形成率(39.13%)显著高于常规方案组(12.81%)(P<0.05)。常规方案组未获得临床妊娠;微刺激组共70个周期进行冻融胚胎移植,临床妊娠22例,移植周期临床妊娠率为31.43%(22/70),累计继续妊娠率为18.87%(20/106)。且微刺激方案中不同年龄组的胚胎种植率、移植周期妊娠率随着年龄增加显著下降(P<0.05)。结论微刺激全胚胎冷冻方案应用于常规IVF-ET治疗失败无优质胚胎的患者可获得较好的妊娠结局,有一定的临床应用价值。

Objective： To explore the clinical value of mild stimulation protocol applied in the normal responders after failure of routine IVF-ET without high quality embryos. Methods： A total of 106 normal responders were initially taken 124 cycles with conventional protocols. After unsuccessful pregnancy due to no high quality embryos, another 156 mild stimulation protocols were applied. A retrospective study was performed to compare the various parameters and clinical outcomes between the two protocols. Results： The days of gonadotropin （Gn） used [（7.24±2.41） vs. （10.59±1.81） days],the total doses of Gn used [（656.97±347.17） vs. （2 409.54±726.01） U],E2 levels on HCG day [（451.46± 350.85） vs. （1 275.93±674.46） pmol/L],and the number of mature oocytes [（2.53±2.15） vs. （8.98± 5.29）1 were significantly lower in mild stimulation protocol than those of the conventional protocol （P〈 0.05）,but the embryonic formation rate per oocyte （39.13%） in the mild stimulation protocol was significantly higher than that in the conventional protocol （12.81%） （P〈0.05）, There was no clinical pregnancy in the conventional group. Twenty-two clinical pregnancies were obtained in the 70 transfer cycles in the mild stimulation protocol. The clinical pregnancy rate was 31.43% （22/70）, and the cumulative ongoing pregnancy rate was 18.87% （20/106）. The embryo implantation rate and pregnancy rate in different age groups were significantly decreased along with age increased （P〈0.05）. Conclusions.. Mild stimulation protocol used in the normal responders after failure of routine IVF-ET without high quality embryos can obtain good clinical outcomes.