控制性卵巢刺激中慢反应患者添加低剂量人绒毛膜促性腺激素的临床观察

Clinical observation of low dose human chorionic gonadotropin in patients with suboptimal ovarian response in controlled ovarian stimulation

目的探讨卵巢慢反应(suboptimal ovarian response,SOR)患者促排卵治疗中添加低剂量人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)的效果。方法回顾性分析2011年3月至2015年12月于中山大学孙逸仙纪念医院采用促性腺激素释放激素激动剂长方案出现SOR的38例患者的临床资料,将38个SOR周期与22个自身对照周期进行比较。结果 SOR周期的促性腺激素(gonadotropin,Gn)启动剂量、Gn使用天数、Gn总量和自身对照周期比较差异无统计学意义(P>0.05)。SOR周期启动日卵泡刺激素和hCG日黄体生成素水平均显著低于自身对照周期(P<0.05)。两组周期取消率、获卵数、2PN受精率、卵裂率、移植胚胎数、冷冻胚胎数、可利用胚胎数、种植率和临床妊娠率等指标比较,差异均无统计学意义(P>0.05)。结论 SOR者添加低剂量hCG可以改善卵巢反应性,并获得和卵巢正常反应周期相似的妊娠结局。

Objective To evaluate the effect of low-dose human chorionic gonadotropin（ hCG） supplementation during controlled ovarian stimulation in patients with suboptimal ovarian response（ SOR）. Methods Retrospective analyzed 38 patients with SOR in long-term gonadotropin-releasing hormone agonist regimen from March 2011 to December 2015 in Memorial Hospital of Sun Yat-Sen University. Compared 38 ovarian slow response cycles with 22 self-control cycles. Results There were no differences in the starting dose,duration and consumption of gonadotropins between suboptimal response cycles and normal response cycles（ P〈0. 05）. The levels of follicle-stimulating hormone on the first day of ovarian stimulation and luteinizing hormone concentrations on hCG day were significantly lower in suboptimal response cycles than in the self-controlled cycles（ P〈0. 05）. Cycle cancelation rate,oocytes retrieved,2 PN fertilization rate,cleavage rate,transferred embryos,frozen embryos,available embryos,implantation rate and clinical rate were comparable between suboptimal response cycles and normal response cycles（ P〈0. 05）. Conclusion With the supplementation of low-dose hCG,the patients of SOR could improve the ovarian response and achieve similar pregnancy outcome as compared with normal response cycle.