卵泡期高孕酮状态下促排卵方案与长方案促排卵在高龄卵巢功能低下患者中的应用效果比较

Application effects of progestin-primed ovarian stimulation protocol in follicular phase versus prolonged protocol of ovarian stimulation on elderly patients with poor ovarian response:a comparative study

目的 比较卵泡期高孕酮状态下促排卵(PPOS)方案与长方案促排卵在高龄卵巢功能低下(POR)患者应用效果。方法纳入80例POR患者,年龄≥38岁,均接受体外受精/卵胞浆内单精子显微注射-胚胎移植助孕治疗。随机分为长方案组及PPOS组各40例,分别采用促性腺激素释放激素激动剂的长方案和卵泡期PPOS方案进行促排卵。比较两组患者扳机日的优势卵泡数、卵泡刺激素(FSH)、血清雌二醇、黄体生成素(LH)和孕酮水平及获卵数、两原核(2PN)受精率、优胚率、可移植胚胎率、周期取消率及妊娠结局。结果扳机日,PPOS组患者FSH、雌二醇水平低于长方案组,而孕酮、LH水平高于长方案组(均P<0.05)。PPOS组的2PN受精率、优胚率高于长方案组(均P<0.05)。两组的卵裂率、胚胎种植率、临床妊娠率、生化妊娠率、活产率、流产率比较,差异均无统计学意义(均P>0.05)。结论与长方案促排卵比较,卵泡期PPOS方案能有效提高高龄POR患者的促排卵效果及胚胎质量。

Objective To compare the application effects of progestin-primed ovarian stimulation(PPOS) protocol in follicular phase versus prolonged protocol of ovarian stimulation among elderly patients with poor ovarian response (POR). Methods Eighty POR patients aged 38 years and above undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET) were enrolled and randomly divided into prolonged protocol group ( n =40) and PPOS group( n =40),and a prolonged protocol of gonadotropin-releasing hormone agonists and an in-follicular-phase protocol of PPOS were performed separately for ovarian stimulation in the two groups.Number of dominant follicles on the trigger day,and follicle-stimulating hormone(FSH),serum estradiol,luteinizing hormone(LH) and progesterone levels were compared between the two groups,and number of eggs obtained,two-pronuclear zygote(2PN) fertilization rate,excellent embryo rate,transplantable embryo rate,cycle cancellation rate,and pregnancy outcome were compared as well. Results On the trigger day,the PPOS group had lower levels of FSH and estradiol and higher levels of progesterone and LH than the prolonged protocol group(all P <0.05).The 2PN fertilization rate,and excellent embryo rate of the PPOS group were higher than those of the prolonged protocol group(all P <0.05).There were no statistically significant differences between the two groups in cleavage rate,embryo implantation rate,clinical pregnancy rate, biochemical pregnancy rate,live birth rate,or abortion rate(all P >0.05). Conclusion Compared with prolonged protocol of ovarian stimulation,PPOS protocol in follicular phase can effectively improve efficacy of ovarian stimulation as well as embryo quality in elderly patients with POR.