不同促排卵药物黄体期促排卵对卵巢低反应患者卵巢反应性的影响

The effect of different ovulation stimulating agents during luteal stage of ovarian hyperstimulation (POR) patients on ovarian response to ovulation

目的探讨不同促排卵药对卵巢低反应(POR)患者黄体期促排卵过程中卵巢反应性的影响。方法前瞻性随机对照分析首都医科大学附属北京妇产医院2014年5月至2017年1月接受IVF-ET的108例POR患者的所有统计学资料。按照促排卵药将受试者分为三组:HMG组,来曲唑组和氯米芬组,并比较各组间基线数据和卵巢反应性数据。结果在108例POR患者中,HMG组患者36例,来曲唑组36例,氯米芬组36例。在三组中,黄体期促排卵的促排天数和促排药量均高于卵泡期促排卵,组间差异均存在统计学意义(P<0.05);在来曲唑组,黄体期促排卵的h CG日14~16mm的卵泡数比卵泡期促排卵多,组间差异存在统计学意义(P<0.05);在氯米氛组,黄体期促排卵的h CG日12~14mm的卵泡数比卵泡期促排卵低(P<0.05),但是成熟卵率及受精率均比卵泡期促排卵高(P<0.05)。在三组中,平均获卵数、平均成熟卵数、平均受精卵数、平均胚胎数、平均优质胚胎数、平均冷冻胚胎数、取消周期率、卵子获得率和卵裂率在卵泡期促排卵和黄体期促排卵两种促排卵方案中组间差异均未见统计学意义(P>0.05)。结论对于卵巢低反应患者而言,黄体期促排卵治疗具备一定的临床治疗价值,但是促排天数及促排药量有所增加。氯米芬应用与POR患者行黄体期促排卵治疗可能具有一定的优势。

Objective：To investigate the effect of different ovulation stimulating agents on ovarian response to ovulation during luteal stage of ovarian hyperstimulation（POR）patients. Methods：A prospective randomized controlled study was conducted on 108 POR patients who received IVF-ET in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University from May 2014 to January 2017. According to the ovulation drugs subjects were divided into three groups：HMG group,letrozole group and clomiphene group,and compared between baseline data and ovarian response data. Results：In 108 POR patients,36 patients of the HMG group,36 patients of the letrozole group,36 patients of the clomiphene group. In the three groups,the days and the dosage of ovulation induction in the luteal phase ovulation was higher than that in the follicular stage ovulation,the differences between groups had statistically significant（P〈0.05）;in the letrozole group,the number of 14~16 mm follicles of the h CG day in the luteal stage ovulation was more than follicular stage ovulation,the difference between groups had statistical significance（P〈0.05）;in the clomiphene group,the number of 12~14 mm follicles of the h CG day in the luteal stage ovulation was less than follicular stage ovulation（P〈0.05）,but the maturation rate and fertilization rate were higher than follicular stage ovulation（P〈0.05）. In the three groups,for the average number of oocytes,the average number of mature eggs,average number of fertilized eggs,the average number of embryos,the average number of high quality embryos,the average number of frozen embryos,cancel the cycle rate,egg rate and cleavage rate of ovulation promoting ovulation,there were no statistically significant in the difference between the groups of the follicular stage ovulation and luteal stage ovulation（P〈0.05）. Conclusion：For the patients with ovarian hyperstimulation,the treatment of luteal stage ovulation has a certain value for clinical treatment,but the number of the days and the dosage is increased. The application of clomiphene and the treatment of the patients with ovarian hyperstimulation in luteal stage ovulation may have certain advantages.