高孕激素促排卵在长方案移植失败患者行IVF/ICSI中的疗效

Prediction and analysis of progestin primed ovarian stimulation in patients who failed in implantation of GnRH agonist long protocol undergoing IVF/ICSI

目的:探讨长方案移植失败≥2次的患者使用高孕激素促排卵(PPOS)的临床效果。方法:回顾性分析278例在外院生殖中心有≥2次长方案移植失败史并于上海交通大学医学院附属第九人民医院使用PPOS方案的患者,分析其PPOS方案和既往长方案的促排卵和妊娠结局。结果:长方案移植失败≥2次的患者在PPOS方案的获卵数、可用胚胎数和卵子利用率显著少于既往长方案(P<0.05)。PPOS方案冻融胚胎移植(FET)周期中,每周期移植胚胎数少于既往长方案(P<0.01),获得的临床妊娠率、胚胎种植率和活产率分别为49.2%、31.4%和41.7%。其中,既往长方案仅接受过FET的患者,在PPOS方案FET的临床妊娠率、胚胎种植率和活产率分别为45.2%、30.2%和41.1%。结论:长方案移植失败≥2次的患者使用PPOS方案可以获得良好的妊娠结局,可能原因在于提高卵母细胞和胚胎的质量。PPOS方案可以作为这类患者的有效替代促排卵方案。

Objective： To analyze the clinical outcomes of progestin primed ovarian stimulation in patients with no less than two implantation failures in long protocol. Methods： A retrospective study including 278 patients who had ≥2 implantation failures in long protocol and received PPOS subsequently was performed. The ovarian stimulation and pregnancy outcomes were compared between PPOS and previous long protocol. Results： For patients with ≥ 2 implantation failures of long protocol, the number of retrieved oocytes, viable embryos and the viable embryo rate per oocyte in PPOS were less than long protocol（P〈0.05）. In FET cycles of PPOS, these patients transferred less embryos per cycle than long protocol（P〈0.01）, with the clinical pregnancy rate, implantation rate and live birth rate of 49.2%, 31.4% and 41.7%. Among these specific women, patients who only received FET in previous long protocol gained the clinical pregnancy rate, implantation rate and live birth rate of 45.2%, 30.2% and 41.1% in FET cycles of PPOS. Conclusion： Patients with no less than two implantation failures in long protocol can obtain acceptable pregnancy outcomes in PPOS, and the possible reason may be the improvement in quanlity of oocytes and embryos. PPOS can be an efficient alternative protocol for these patients.