微刺激方案在反复常规IVF-ET治疗失败无可移植胚胎患者中的应用

Application of mild stimulation protocol in patients with repeated failure of traditional IVF without transplantable embryo

目的探讨微刺激方案在反复常规IVF-ET治疗失败无可移植胚胎患者中的应用价值。方法回顾性分析2016年9月至2018年4月在我中心行助孕治疗,反复常规IVF治疗失败无可移植胚胎患者行微刺激方案促排卵的病例资料,共纳入130例患者(共329个周期)。按照患者卵巢功能分为:卵巢低反应(POR)组(95例患者,257个周期)和对照组(35例患者,72个周期),比较两组患者微刺激方案治疗后的妊娠结局。结果与对照组相比,POR组患者Gn总剂量、每周期获卵数、成熟卵母细胞数、正常受精卵个数、每周期冷冻胚胎数显著减少(P<0.05)。POR组周期取消率显著高于对照组(49.42%vs.36.11%,P<0.05);两组患者获卵率比较无显著性差异(64.12%vs.64.33%,P>0.05)。POR组的受精率显著低于对照组(77.54%vs.86.55%),但卵裂率显著优于对照组(86.90%vs.69.42%)(P<0.05)。进行移植的两组患者FET周期的每移植周期生化妊娠率、每移植周期临床妊娠率、胚胎种植率比较均无显著性差异(P>0.05),但POR组的起始周期妊娠率(12.45%vs.27.78%)和累计临床妊娠率(49.23%vs.76.92%)均显著低于对照组(P<0.05)。结论微刺激方案对于反复常规IVF治疗失败无可移植胚胎的患者,有可能改善卵母细胞质量而获得可移植胚胎,通过多次微刺激治疗仍可获得不错的妊娠率;但微刺激方案治疗中的高周期取消率不容忽视。

Objective:To evaluate the efficacy of mild stimulation protocol in patients with repeated failure of conventional IVF-ET without transplantable embryo.Methods:The data of 130 patients(329 cycles)who received ovulation induction with micro-stimulation protocol after repeated failure of conventional IVF treatment without transplantable embryos in our center from September 2016 to April 2018 were retrospectively analyzed.The patients were divided into two groups according to their ovarian function:poor ovarian response(POR)group(95 patients,257 cycles)and control group(35 patients,72 cycles).The pregnancy outcomes were compared between the two groups.Results:Compared with the control group,the total dose of gonadotropin(Gn),the number of oocytes retrieved per cycle,number of mature oocytes,number of normal fertilized oocytes and number of frozen embryos per cycle in POR group were decreased significantly(P<0.05).The cycle cancelation rate in POR group was significantly higher than that in the normal group(49.42%vs.36.11%,P<0.05).There was no significant difference in the oocytes retrieval rate between the two groups(64.12%vs.64.33%,P>0.05).The fertilization rate of POR group was significantly lower(77.54%vs.86.55%),but the cleavage rate(86.90%vs.69.42%)was significantly higher than that of control group(P<0.05).There were no significant differences in biochemical pregnancy rate,clinical pregnancy rate per cycle and embryo implantation rate during FET cycle between the two groups(P>0.05).However,the pregnancy rate of initial cycle(12.45%vs.27.78%)and cumulative clinical pregnancy rate(49.23%vs.76.92%)were significantly decreased in POR group compared to the control group(P<0.05).Conclusions:Mild stimulation protocol may improve oocyte quality to obtain transplantable embryos in patients with repeated failure of conventional IVF without transplantable embryo.Good pregnancy rate can be achieved through multiple micro-stimulation therapy,but the high cycle cancellation rate in micro-stimulation therapy cannot be ignored.