标准长方案超促排卵不同卵巢反应的相关分析

Correlation analysis of different ovarian responses to standard long protocol controlled ovarian hyperstimulation

目的对标准长方案控制性超促排卵(controlled ovarian hyperstimulation,COH)过程中出现的不同卵巢反应进行相关分析,评价卵巢储备相关指标变化。方法选取成都中医药大学第二附属医院生殖医学中心2013~2014年收治的卵巢储备评估正常的不孕患者,在行标准长方案体外受精-胚胎移植或卵母细胞质内单精子显微注射治疗的304例,依据取卵日获卵数水平分成3组:L组(低反应组,41例),获卵数≤4个;N组(正常反应组,226例),5个≤获卵数≤14个;H组(高反应组,37例),获卵数≥15个。回顾性分析比较各组临床资料、治疗经过及妊娠结局。结果 H组基础卵泡刺激素(basic follicle-stimulating hormone,bFSH)低于N组,L组bFSH/基础黄体生成素(basic luteal hormone,bLH)高于N组。治疗经过及结局:3组间促性腺激素使用总量、使用天数以及人绒毛膜促性腺激素注射日LH、雌二醇(estradiol,E_2)、孕酮(progesterone,P)两两比较差异无统计学意义(P>0.05)。L组E_2/P小于N组,优胚率高于N组;H组周期取消率大于N组,差异均有统计学意义(P<0.05)。获卵数、成熟卵数、2 PN数、优胚数两两比较差异有统计学意义(P<0.05),且随着获卵数增多,成熟卵数、2 PN数、优胚数均增高。鲜胚移植临床妊娠率、流产率各组比较差异无统计学意义(P>0.05)。结论评估7≤基础窦卵泡数≤13的标准长方案COH时,当bFSH>7mIU/mL、FSH/LH比值>1.84时有出现卵巢低反应倾向;而bFSH<5.79 mIU/mL、FSH/LH比值<1.48时更易发生卵巢高反应。COH中联合应用多个指标评估卵巢储备功能,对预测卵巢发生非预期异常反应,提高其预测效能具有一定的临床价值。

Objective To conduct correlation analysis on different ovarian responses among patients to standard long protocol controlled ovarian hyperstimulation（COH）. Methods Retrospectively analyzed a total of 304 long protocol IVF/ICSI - ET treatment cycles at The Second Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2013 to December 2014 on patients aged between 25 and 35 with normal ovarian reserve. According to the number of retrieved oocytes on the day of hCG trigger, the patients were divided into 3 groups - group L （poor ovarian response, n = 41 ） ： the number of retrieved oocytes ≤ 4; group N （ normal ovarian response, n = 226 ） ： 5 ≤ the number of retrieved oocytes ≤ 14 ; and group H （ high ovarian response, n = 37 ） ： the number of retrieved oocytes ≥15. Basic clinic data, treatment and pregnancy outcomes were compared among the groups. Results The basic follicle - stimulating hormone （Bfsh） value of group H was significantly lower than that of group N. The value of Bfsh/basic luteal hormone （bLH） of group L was significantly higher than that of group N （P 〈 0.05 ）. Treatment and pregnancy outcomes： There were no significant differences among the 3 groups in the application amount of gonadotropin （ Gn）, the Gn application hours or the values of LH, estradiol （ E2 ） and progesterone （P） on the day of hCG injection. The Ez/P value of group L was significantly lower than that of group N （P 〈 0. 05 ）. As the number of retrieved oocytes increased, the number of mature oocytes, the diploid number of fertilizations（2PN） and the number of high quality embryos increased（ P 〈 0.05 ）. The rate of high quality embryos of group L was significantly higher than that of group N. The rate of cycle cancellation of group H was significantly higher than that of group N （ P 〈 0. 05 ）. The rate of clinic pregnancy of fresh embryo transfer and the abortion rate are statistically insignificant（ P 〉0. 05 ）. Conclusion Estimating long protocol in COH with 7≤AFC≤13, when bFSH 〉 7mIU/mL and FSH/LH 〉 1.84,a low ovarian response tends to occur; when bFSH 〈 5.79mIU/m1 and FSH/LH 〈 1.48 ,a high ovarian reaction is more likely to occur. Combining multiple indicators for assessing the ovarian reserve in COH can enable the forecast of unexpected abnormal ovary reactions and improve the forecasting efficacy.