不同促排卵方案在卵巢储备功能减退患者中的应用

Application of Different Ovulation Induction Schemes in Patients with Diminished Ovarian Reserve

目的:探讨三种不同促排卵方案在卵巢储备功能减退(DOR)患者中的应用。方法:回顾性分析我院生殖医学中心接受体外受精/卵胞质内单精子显微注射(IVF/ICSI)助孕DOR患者150个周期的临床资料,其中改良激动剂方案51个周期,微刺激方案47个周期,拮抗剂方案52个周期。比较三组患者的各项临床指标及妊娠结局。结果:三组患者的年龄、不孕年限、基础窦卵泡计数(AFC)、抗苗勒管激素(AMH)、血清基础卵泡刺激素(FSH)、血清基础黄体生成素(LH)、血清基础雌二醇(E2)和扳机日孕酮水平,差异均无统计学意义(均P>0.05)。三组患者人绝经期促性腺激素(hMG)使用量、hMG使用天数、扳机日LH及E2值,差异均有统计学意义(均P<0.05)。进一步分析发现,微刺激方案的hMG使用量及使用天数均低于改良激动剂方案,微刺激方案和拮抗剂方案的扳机日LH水平明显高于改良激动剂方案,拮抗剂方案的扳机日E2水平明显高于微刺激方案,差异均有统计学意义(均P<0.05)。三组患者扳机日子宫内膜厚度、获卵数、MII期卵母细胞比率、受精率、胚胎数、优胚率、临床妊娠率,差异均无统计学意义(均P>0.05)。三组患者的周期取消率及早期流产率,差异均有统计学差异(均P<0.05)。进一步分析发现,微刺激方案的周期取消率明显高于改良激动剂方案和拮抗剂方案,拮抗剂方案的早期流产率明显高于改良激动剂方案和微刺激方案,差异均有统计学差异(均P<0.05)。结论:三种促排卵方案在DOR人群应用中妊娠率无明显差异。微刺激方案hMG使用量最少,拮抗剂方案早期流产率最高。对于DOR患者,三种促排卵方案均可行,微刺激方案更经济。

Objective:To investigate the application of three different ovulation induction schemes in patients with diminished ovarian reserve(DOR).Methods:The clinical data of 150 cycles of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)assisted DOR in the reproductive medicine center of our hospital were retrospectively analyzed,including 51 cycles of modified agonist regimen,47 cycles of microstimulation regimen and 52 cycles of antagonist regimen.Then,the clinical observation indexes and pregnancy outcomes were evaluated.Results:There were no significant differences in age,infertility years,basal sinus follicular count(AFC),anti mullerian hormone(AMH),serum basal follicular stimulating hormone(FSH),serum basal luteinocyte(LH),serum basal estradiol(E2)and progesterone level on the trigger day among three groups(All P>0.05).However,the dosage and duration of human menopausal gonadotropin(hMG)using,LH and E2 values on the trigger day performed significant differences among these three groups(All P<0.05).Further analysis showed that the dosage and duration of hMG using were lower in microstimulation regimen when compared with the modified agonist regimen,LH level on trigger day in microstimulation regimen and antagonist regimen were both significantly higher than that in modified agonist regimen,and the E2 level on trigger day in antagonist regimen was significantly higher than that in microstimulation regimen(All P<0.05).There were no significant differences in intrauterine thickness on trigger day,number of eggs obtained,oocyte ratio at MII stage,fertilization rate,number of embryos,optimal embryo rate and clinical pregnancy rate among three groups(All P>0.05).Cycle cancellation rate and early abortion rate showed significant differences among the three groups(All P <0.05).Further analysis showed that the cycle cancellation rate of the microstimulation regimen was significantly higher than that of the modified agonist regimen and the antagonist regimen,and the early abortion rate of the antagonist regimen was significantly higher than that of the modified agonist regimen and the microstimulation regimen(All P <0.05).Conclusion:There was no significant difference of pregnancy rate in DOR among three ovulation induction schemes.The dosage of hMG in microstimulation regimen was the lowest,and the early abortion rate in antagonist regimen was the highest.For patients with DOR,all three ovulation induction schemes are feasible,and microstimulation is more economical.