卵泡期高孕激素状态下促排卵方案在高龄卵巢低反应患者中的治疗结局分析

Progestin-primed ovarian stimulation in poor ovarian responders at advanced age

目的研究卵泡期高孕激素状态下促排卵方案(PPOS)在高龄卵巢低反应患者中应用的可行性,为高龄卵巢低反应患者的临床治疗探索新思路、新方法。方法回顾性分析2016年6月至2017年4月在我院生殖中心行IVF/ICSI助孕的高龄卵巢低反应患者的一般情况、促性腺激素(Gn)使用情况、IVF/ICSI相关指标。研究共纳入388个周期,所有纳入患者均符合卵巢低反应博洛尼亚共识诊断标准。根据患者采用促排卵方案的不同,分成PPOS组(216个周期)和拮抗剂组(172个周期),比较两组患者的促排卵结局及行冻融胚胎移植(FET)的妊娠结局。结果两组患者的年龄、不孕年限、体重指数(BMI)、基础抗苗勒管激素、基础窦卵泡数等比较均无显著性差异(P>0.05)。对于高龄卵巢低反应患者,两种促排卵方案的平均获卵数、Gn使用天数、受精率、每卵子可利用胚胎率、优质胚胎率比较均无显著性差异(P>0.05),但PPOS组的Gn总用量显著低于拮抗剂组[(1 687.32±807.44)vs.(1 864.98±734.11)U,P<0.05)。FET妊娠结局比较,PPOS组的生化妊娠率(19.09%vs.17.10%)、种植率(8.97%vs.8.72%)及临床妊娠率(11.82%vs.10.62%)有高于拮抗剂组的趋势,但尚无显著性差异(P>0.05)。拮抗剂组中有2例患者出现早发LH峰,PPOS组中无患者出现早发LH峰。结论对于高龄卵巢低反应患者,使用PPOS方案可以有效抑制早发LH峰。与拮抗剂方案相比,PPOS方案可以降低Gn总用量,既为高龄患者改善妊娠结局提供可能,也可减轻患者的经济负担,可作为高龄卵巢低反应患者备用促排卵方案之一。

Objective ： To evaluate the efficacy of progestin-primed ovarian stimulation（PPOS）protocol in poor ovarian responders （POR） at advanced age.Methods ： The data of 399 cycles in PORs at advanced age met the criteria of Bologna consensus in our Reproductive Medicine Research Center from June 2016 to April 2017 were included in this retrospective study.The patients with PPOS were as PPOS group （ n =216）,while the antagonist group （ n =172） consisted of the patients with antagonist protocol.Both laboratory and clinical outcomes after frozen-thawed embryo transfer （FET） were compared between the two groups.Results ： The baseline characters,such as age,duration of infertility,BMI,anti-mullerian hormone and antral follicles counts,were comparable between the two groups.No statistical significance was found in number of oocyte retrieval,duration of Gn used,fertilization rate,available embryo rate per oocyte retrieved,high quality embryo rate.The patients in PPOS group used significantly less Gn doses than antagonist group [（1 687.32±807.44） vs.（1 864.98±734.11） U] （ P 〈0.05）.For clinical outcomes of FET,PPOS group tended to have higher chemical pregnancy rate （19.09% vs.17.10%）,implantation rate （8.97% vs.8.72%） and clinical pregnancy rate （11.82% vs.10.62%）,although the difference was not significant （ P 〉0.05）.In addition,two patients in antagonist group experienced premature LH surge,while no one did in PPOS group.Conclusions ： For PORs at advanced age,PPOS protocol can effectively control premature LH surge and reduce Gn doses.It can not only improve the pregnancy outcome for elderly patients,but also reduce the financial burden of patients.PPOS protocol might be an effective alternative in PORs at advanced age.