GnRH-a/Gn长方案控制性卵巢刺激中卵巢慢反应患者的影响因素

Influencing factors related to suboptimal ovarian response in patients with controlled ovarian stimulation by GnRH-a/Gn long protocol

目的探讨在体外受精—胚胎移植周期中采用促性腺激素释放激素激动剂/促性腺激素(GnRH-a/Gn)长方案控制性卵巢刺激治疗中出现卵巢慢反应患者的影响因素。方法采用GnRH-a/Gn长方案进行卵巢控制性刺激出现卵巢慢反应的患者资料(卵巢慢反应组),共38例,38个周期;选取同期采用相同方案进行控制性卵巢刺激卵巢反应正常(5个<获卵数<20个)的患者(卵巢反应正常组),共172例,172个周期。比较分析2组患者年龄、孕产史、卵巢手术史、体重指数、血脂水平(甘油三脂、总胆固醇、高密度脂蛋白和低密度脂蛋白)、基础血激素水平、促甲状腺激素、窦卵泡数、降调后血清雌二醇、降调后血清促黄体生成素值及促性腺激素启动剂量与卵巢慢反应的关系。结果患者年龄、孕产史、体重指数、血脂水平、基础血激素水平、促甲状腺激素及窦卵泡数,在2组之间均无统计学差异;降调后促黄体生成素值卵巢慢反应组低于卵巢反应正常组(P<0.05);卵巢手术史与卵巢慢反应的发生呈正相关(P<0.05);其余均无统计学意义。结论促性腺激素释放激素激动剂降调后促黄体生成素值过低,预示卵巢慢反应,且卵巢手术史是发生卵巢慢反应的高危因素。

Objective To explore the influential factors of suboptimal ovarian response in infertile patients undergoing gonadotropin releasing hormone agonist/gonadotropin（GnRH-a/Gn） long protocol in controlled ovarian stimulation for in vitro fertilization and embryo transfer（IVF-ET） cycles,since there is a positive correlation between ovarian operation history and suboptimal ovarian response.Methods Retrospective analysis was conducted of infertile women with slow ovarian response who had undergone IVF/ICSI treatment by conventional GnRH-a/Gn long protocol from Janary 2014 to Janary 2016 at Reproductive Medicine Hospital,First Hospital of Lanzhou University,with a total of 38 cases including 38 cycles（a slow response group）;172 cases including 172 cycles in a normal ovarian response group（5 numbers of follicle obtained 20） which were treated with the same protocol at the same period.The ages of patients,pregnancy history,history of ovarian surgery,body mass index,blood lipid level,basic sex hormones,follicle stimulating hormone（FSH）,initial antral follicle count,estradiol and luteinizing hormone levels after down-regulation,application doses of Gn were all compared between the two groups,to probe their relations with slow ovarian response.Results The age,pregnancy history,body mass index,blood lipid level,basic sex hormones,FSH,initial antral follicle count had manifested significant difference between the suboptimal ovarian responders and normal ovarian responders（P〈0.05）.luteinizing hormone levels after pituitary down-regulation in slow response group was statistically significantly lower than that in the normal ovarian response group（P〈0.05）.Others showed no statistical difference.Conclusion The low levels of luteinizing hormone after Gonadotropin releasing hormone agonist down-regulation may predict a slow ovarian response.And operations on ovary are a high risk factor of suboptimal ovarian response.