高孕激素状态下促排卵与拮抗剂方案应用于卵巢低反应患者的促排卵疗效比较

Comparison of efficacy between progestin-primed ovarian stimulation and GnRH antagonist protocol in poor ovarian responders

目的比较高孕激素状态下促排卵方案与拮抗剂方案在卵巢低反应(POR)患者中应用的临床效果。方法回顾分析2015年10月至2016年10月在我院生殖中心行IVF/ICSI助孕的236例卵巢低反应患者的临床资料,其中116例采用高孕激素状态促排卵(PPOS)方案,120例采用拮抗剂方案,比较两组患者的基本情况及促排卵结局。结果两组患者年龄、基础性激素水平等一般资料比较无显著差异(P>0.05);两组患者Gn用量[(2 729.25±1 048.50)U vs.(2 769.75±1 055.25)U]、直径≥14mm卵泡数[(3.51±2.44)vs.(3.95±2.77)]、获卵数[(2.86±2.05)vs.(2.86±2.27)]、无可移植胚胎周期取消率(29.3%vs.30.0%)比较亦无统计学差异(P>0.05)。PPOS方案组2PN受精率(60.8%vs.58.6%)、卵裂率(83.5%vs.82.3%)、优胚率(54.0%vs.46.7%)及取卵周期取消率(6.0%vs.5.8%)略高于拮抗剂组,但差异无统计学意义(P>0.05),但PPOS方案组可移植胚胎率显著高于拮抗剂方案组(72.2%vs.60.9%,P<0.05)。PPOS方案组与拮抗剂组的Gn天数[(11.11±4.09)vs.(9.73±2.68)]、早发LH峰发生率(0vs.6.7%)有统计学差异(P<0.05)。结论高孕激素状态下促排卵方案在POR患者能较好地抑制早发LH峰,增加可移植胚胎率,对于POR患者是较为理想的促排卵方案。

Objective： To compare the efficacy between progestin-primed ovarian stimulation（PPOS） and GnRH antagonist（GnRH-ant） protocol in poor ovarian responders undergone IVF. Methods： A retrospective analysis was performed in a total of 236 patients received artificial reproductive technology（ART） from October 2015 to October 2016. Among them, 116 cycles were administered in progestin-primed ovarian stimulation protocol, while 120 cycles were adopted GnRH-ant protocol. The general conditions and the ovulation induction of the two groups were compared. Results： There were no significant differences in general condition and basic hormone levels between the two groups（P〉0.05）. The amount of gonadotropin used F（2 729.25±1 048.5）U vs. （2 769.75±1 055.25） U],number of follicles with diameter ≥14 mm on the HCG day [（3.51±2.44） vs. （3.95±2.77）],number of retrieved oocytes [（2.86±2.05） vs. （2.86±2.27）],cycle cancellation rate due to no available embryos（29.3 % vs. 30 %） were not significantly different between the two groups（all P〉0.05）. The 2PN fertilization rate（60.8% vs. 58.6%） ,cleavage rate（83.5% vs. 82.3%） ,high-quality embryo rate （54.0% vs. 46.7%） and cycle cancellation rate（6.0% vs. 5.8%） in PPOS group were slightly higher than those in GnRH-ant protocol group（P〉0.05）. However,the rate of utilized embryos（72.2% vs. 60.9%） in PPOS group was significantly higher than the GnRH-ant protocol group （P〈0.05）. The duration of gonadotropinused [（11.11±4. 09） vs. （9.73±2.68） days] and the occurrence of premature LH surge [0 vs. 6.7%] were significantly different（P〈0. 05）. Conclusions： Progestin-primed ovarian stimulation protocol can effectively inhibit the premature LH surges and increase transplantable embryo rate, which can be served as an alternative and ideal treatment protocol for the poor ovarian responders.