卵泡期高孕激素状态下促排卵在卵巢储备功能低下患者中的应用

Effect of progestin-primed ovarian stimulation scheme in patients with diminished ovarian reserve

目的:比较3种不同的促排方案在卵巢储备功能低下(DOR)患者中促排的胚胎实验室结局,以探索卵泡期高孕激素状态下促排卵(PPOS)在DOR患者中的应用价值。方法:回顾性分析2015年11月至2016年7月期间来温州医科大学附属第二医院育英儿童医院生殖中心接受体外受精/胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗的DOR患者共228周期,根据促排情况分成3组:A组(卵泡期PPOS方案组,87周期),B组(黄体期促排卵方案组,45周期),C组(微刺激方案组,96周期)。比较3组的一般情况和促排结局。结果:B组的促性腺激素(Gn)用量显著多于A组和C组,差异有统计学意义(P<0.05),但3组的Gn用药天数差异无统计学意义(P>0.05);A组D3优质胚胎率显著高于C组,差异有统计学意义(P<0.05);但A组与B组、B组与C组间差异均无统计学意义(P>0.05);B组注射人绒毛膜促性腺激素(HCG)日黄体生成素(LH)水平显著低于A组和C组,差异有统计学意义(P<0.05);B组HCG日孕酮(P)水平显著高于C组,差异有统计学意义(P<0.05);A组HCG日P水平与C组比差异无统计学意义(P>0.05);3组间的获卵数、成熟卵数、正常受精卵数、卵裂数、D3优质胚胎数、有效胚胎数、正常受精率、卵裂率、有效胚胎率差异均无统计学意义(P>0.05)。结论:对于DOR患者,卵泡期PPOS方案可以获得更好的D3优质胚胎率,可为此类患者提供一种新的备选促排卵方案。

Objective:To compare the embryo laboratory outcomes of different ovarian stimulation schemes in patients with diminished ovarian reserve,to explore the application value of progestin-primed ovarian stimulation scheme in patients with diminished ovarian reserve.Methods:A total of228cycles of patients with diminished ovarian reserve who received IVF/ICSI-ET treatment from November2015to July2016were analyzed retrospectively.They were divided into progestin-primed ovarian stimulation(Group A,87cycles),luteal-phase stimulation(Group B,45cycles)and mild stimulation(Group C,96cycles)according to treatment protocols.The basic situations and the embryo laboratory outcomes were compared and analyzed between Group A,Group B and Group C.Results:The basic situations in three groups were no significant differences(P>0.05).The dosage of Gn administration in Group B was significantly higher than those in Group A and Group C(P<0.05).The D3quality embryo rate in Group A was significantly higher than Group C(P<0.05).The serum LH level of the patients in Group B on the day of HCG administration was significantly lower than that in Group A and Group C(P<0.05).The serum P level of the patients in Group B on the day of HCG administration was significantly higher than Group C(P<0.05).There were no significant differences in the retrieved oocytes number,mature oocytes number,D3good-quality embryos number,available embryos number,the normal fertilization rate,the cleavage rate,the available embryo rate among three groups(P>0.05).Conclusion:Progestin-primed ovarian stimulation scheme can obtain higher D3quality embryo rate and is a viable regimen for patients with diminished ovarian reserve.