改良自然周期方案用于卵巢储备功能低下患者行体外受精胚胎移植助孕的临床研究

Application of modified natural cycle in IVF-ET for women with diminished ovarian reserve

目的探讨改良自然周期方案用于卵巢储备功能低下患者行体外受精胚胎移植助孕的临床疗效。方法回顾性分析行体外受精胚胎移植助孕的89例卵巢储备功能低下患者(共行体外受精胚胎移植周期245个)的临床资料,包括改良自然周期方案21例(周期48个),高孕激素下促排卵方案29例(周期81个),联合刺激方案39例(周期116个)。分别比较3组患者年龄、不孕原因、不孕年限、基础血清抗缪勒氏管激素(AMH)及卵泡刺激素(FSH)水平、HCG日血清雌二醇(E2)及促黄体生成素(LH)水平、LH最高值、获卵数、可利用胚胎数、优质胚胎数、未获卵率、单周期临床妊娠率、累积临床妊娠率等指标。结果 3组患者年龄、不孕原因、不孕年限、基础血清AMH及FSH水平比较,差异均无统计学意义(均P>0.05)。HCG日血清E2水平为改良自然周期组<高孕激素下促排卵组<联合刺激组(P<0.05)。与高孕激素下促排卵组、联合刺激组比较,改良自然周期组HCG日血清LH水平及卵泡期最高值均明显较高(均P<0.05),获卵数、可利用胚胎数明显较少(均P<0.05),未获卵率明显较高(均P<0.05);但高孕激素下促排卵组与联合刺激组比较,差异均无统计学意义(均P>0.05)。3种体外受精胚胎移植助孕方案患者优质胚胎数、单周期临床妊娠率、累积临床妊娠率比较,差异均无统计学意义(均P>0.05)。结论改良自然周期方案是卵巢储备功能低下患者行体外受精胚胎移植助孕的有效治疗方案,其临床妊娠率与高孕激素下促排卵、联合刺激方案相当,但需把握合适的取卵时机。

Objective To assess the outcome of modified natural cycle in vitro fertilization-embryotransfer（IVF-ET） for infertile women with diminished ovarian reserve. Methods A total of 245 IVF cycles（48 modified natural IVF cycles, 81 PPOS IVF cycles, 116 CC＋HMG IVF cycles） performed on 89 patients with diminished ovarian reserve in Hangzhou Women＇s Hospital were retrospectively reviewed. The clinical data including age, cause of infertility, years of infertility, serum AMH, basic FSH, E2 of HCG day, the highest level of LH, number of oocytes, available embryos, quality embryos, unacquired oocyte rate, pregnancy rate per cycle and accumulated pregnancy rate were collected and analyzed. Results There were no significant differences in the age, cause of infertility, years of infertility, serum AMH or basic FSH among the three groups（P〈0.05）. The E2 of HCG day in the modified natural IVF cycle group was significantly lower than that of PPOS group（P〈0.05）, and latter was significantly lower than that of CC＋HMG IVF cycle group（P〈0.05）. The LH level of HCG day and the highest level of LH in modified natural cycle group were both significantly higher than those in the other two groups（P〈0.05）. The number of oocytes and available embryos in the modified natural cycle group was significantly lower than that in PPOS group（P〈0.05）. The unacquired oocyte rate of modified natural cycle group was significantly higher than the that of other two groups（P〈0.05）. No significant differences were found in LH, the number of oocytes, available embryos and unacquired oocyte rate between PPOS group and CC＋HMG group. The number of quality embryos, the pregnancy rate per cycle and accumulated pregnancy rate in modified natural cycle group were similar to those in other two groups（P〈0.05）. Conclusion Modified natural IVF cycle is an effective method for patients with poor ovarian reserve, but the timing of oocyte retrieval is crucial for this method.