卵巢慢反应患者控制性超促排卵相关因素分析:一项多中心回顾性研究

Related factors of suboptimal ovarian response in controlled ovary hyperstimulation:a multicenter retrospective study

目的探讨控制性超促排卵(COH)过程中发生卵巢慢反应可能的相关因素。方法回顾性分析2014年1月—2016年1月期间于兰州大学第一医院、新疆佳音医院、青海省人民医院、银川市妇幼保健院、广西玉林市妇幼保健院进行促性腺激素释放激素激动剂(GnRH-a)长方案体外受精-胚胎移植(IVF-ET)的144例卵巢慢反应患者的临床资料,与132例卵巢正常反应患者(正常对照组)进行对比。结果与正常对照组相比,慢反应组患者体质量指数(BMI)、促甲状腺激素(TSH)较高,降调节及促排卵时间较长,促性腺激素(Gn)使用后7d平均卵泡直径偏小,雌二醇(E_2)、黄体生成素(LH)低,hCG注射日E_2低,IVF双原核(2PN)卵裂率较高,临床妊娠率低,差异均有统计学意义(P<0.05)。患者年龄、不孕年限、基础卵泡刺激素(FSH)、LH、催乳素(PRL)、E_2、基础卵泡数、hCG注射日孕酮(P)、获卵率、胚胎质量、胚胎种植率、流产率、宫外孕率、继续妊娠率及取消移植率组间均无统计学差异(P>0.05)。结论卵巢慢反应可能与患者BMI过高、甲状腺功能降低及GnRH-a过度抑制相关,较长的Gn天数仍可使慢反应患者获得较好的妊娠结局。

Objective To study the related factors of suboptimal ovarian response in controlled ovarian hyperstimulation（COH）. Methods A total of 144 suboptimal ovarian response patients in in vitro fertilization-embryo transfer（IVF-ET） cycles of gonadotrophin releasing hormone agonist（GnRH-a） protocol from January 2014 to January 2016 were reviewed, including Reproductive Medicine Hospital in the First Hospital of Lanzhou University, Jia Yin Hospital in Xinjiang Province, the People＇s Hospital in Qinghai Province, Maternal and Child Health Hospital in Yinchuan, Maternal and Child Health Hospital in Yulin of Guangxi Province. Totally 132 paients of normal ovarian response were included in control group. The basal indexes, clinical data and results were compared.Results Compared with control group, suboptimal ovarian responser group had higher body mass index（BMI）,thyrotropic hormone（TSH）, longer days of GnRH-a and COH, shorter follicular diameter on the seventh day of COH, lower estradiol（E2）, luteinizing hormone（LH） on the seventh day of COH, lower E2 on the day of hCG administration, higher IVF two pronucleus（2 PN） cleavage rate and lower clinical pregnancy rate, there were differences between the two groups（P〈0.05）. No significant differences were found in age, infertility duration, basal FSH, LH,prolactin（PRL）, E2, antral follicle count, progesterone on the day of hCG administration, oocyte retrieval rate, embryonic quality, embryo implantation rate, abortion rate, ectopic pregnancy rate, ongoing pregnancy rate, implantation cancel rate（P〉0.05）. Conclusion Suboptimal ovarian response is related with higher BMI, lower thyroid function, or excessively GnRH-a depression. Good-quality embryos and satisfied pregnancy outcomes can still be got by extending COH period.