3种不同促排卵方案在高龄不孕患者IVF/ICSI-ET中的临床应用分析

Clinical application of three different controlled ovarian hyperstimulation protocols in vitro fertilization/intracytoplasmic sperm injection and embryo transfer in elderly infertile patients

目的探究高龄女性体外受精-胚胎移植(IVF/ICSI-ET)助孕过程中3种不同促排卵方案的临床结局。方法回顾性分析行助孕治疗且年龄≥35岁共447例患者的首次新鲜周期临床资料,按照促排卵方案不同分为:促性腺激素激动剂(GnRH-α)长方案组(192个周期),GnRH-α短方案组(162个周期),微刺激方案组(93个周期),比较3组病例一般临床资料及助孕结局。结果 (1)3组患者在年龄、不孕年限、基础促黄体生成素(LH)、基础雌激素(E2)上差异无统计学意义。但是,GnRH-α长方案组的基础窦卵数(b AFC)、促性腺激素(Gn)使用天数、获卵数、优质胚胎数明显高于其他两组,差异有统计学意义(P<0.05);(2)3组Gn使用总量、h CG日LH水平,组间差异有统计学意义(P<0.05),其中长方案组的Gn使用总量是最高的,微刺激方案组的h CG日LH水平高于其他两组。GnRH-α长方案组的临床妊娠率和活产率明显高于GnRH-α短方案组和微刺激方案组(P<0.05);(3)微刺激方案组的新鲜周期取消率最高。微刺激方案组与GnRH-α短方案组相比,临床妊娠率和活产率两组间差异无统计学意义。结论 GnRH-α长方案较适用于卵巢功能较好的高龄不孕患者,可取得较好的临床妊娠率及活产率。对于卵巢功能稍差的高龄患者,微刺激方案是一个安全、经济的促排卵方案,值得在合适的患者中推广应用。

Objective To explore the clinical outcome of three different controlled ovarian hyperstimulation protocols in vitro fertilization or intracytoplasmic sperm injection-embryo transfer（IVF/ICSI-ET） in elderly infertile patients.Methods A retrospective analysis was performed in a total of 447 patients aged ≥35 undergoing IVF/ICSI-ET treatment.They were divided into three groups according to the different stimulation protocols：GnRH-α long group（192 cycles）,GnRH-α short group（162 cycles）,micro simulation group（93 cycles）.Finally,The clinical data of 3 groups and the results of assisted pregnancy were compared.Results（1） There were no statistically differences in the age,duration of infertility,the level of basic LH and E2.However,the basic antral follicle（b AFC）,gonadotropin（Gn） time,the number of collected eggs,and high-quality embryos of the GnRH-α long group were significantly higher than those in the other two groups（P0.05）.The total amount of Gn and the level of LH on h CG injection day were statistically differenct between the three groups（P0.05）.（2） The total amount of Gn of the GnRH-α long group was the highest.The level of LH on h CG injection day of the micro simulation group was significantly higher than that in the other two groups.Clinical pregnancy rate and live birth rate of the GnRH-α long group were signicificantly higher than the GnRH-α short group and the micro stimulation group（P0.05）.（3） Cycle cancelled rate of the micro simulation group was the highest.There was no significant differences of the clinical pregnancy rate and live birth rate between the GnRH-α short program group and the micro stimulation group.But the micro stimulation group had a slightly higher trend.Conclusion The GnRH-α long protocal is more suitable for those elderly patients with better ovarian function and can achieve better clinical pregnancy rate and live birth rate.For those elderly patients with slightly less ovarian function,the micro stimulation protocal is a safe and economical ovulation program that deserves to be used in the right patients.