反复控制性卵巢刺激对卵巢储备功能及反应性的影响

Impact of repeated controlled ovarian stimulation on ovarian reserve and response

目的评价利用辅助生殖技术治疗时,反复控制性卵巢刺激(COS)对卵巢储备功能及反应性的影响。方法回顾性分析2016年1月至2018年12月于西北妇女儿童医院生殖中心接受IVF/ICSI-ET治疗、行2~4个COS周期患者的病历资料,其中行2个周期治疗的患者1898例(共3796周期),行3个周期治疗的患者275例(共825周期),行4个周期治疗的患者68例(共272周期),比较多次COS后患者的基础激素水平、窦卵泡数(AFC)变化,以及不同治疗周期Gn总量、促排卵时间、获卵数、获卵率、正常受精率、可用胚胎数、可用胚胎率、优质胚胎数、优质胚胎率间的差异。结果随COS治疗周期数增加,患者年龄逐渐增加,但患者各周期促排卵前月经第2~4天基础激素水平(FSH、LH、E 2)和AFC差异均无统计学意义(P>0.05)。(1)与首次COS相比,行2个治疗周期患者的第2周期Gn用量、获卵数、获卵率、正常受精率、可用胚胎数、可用胚胎率、优质胚胎数、优质胚胎率均显著增加(P<0.05),而促排卵时间无显著性差异(P>0.05)。(2)与首次COS相比,行3个治疗周期患者的第2、3周期正常受精率、可用胚胎数、可用胚胎率、优质胚胎数及优质胚胎率均显著升高(P<0.05),而Gn用量、促排卵时间、获卵数差异均无统计学意义(P>0.05);获卵率在第2个周期最低,与第1、3周期比较差异均有统计学意义(P<0.05)。(3)与首次COS相比,行4个治疗周期患者的Gn用量、促排卵时间、获卵数、可用胚胎数、可用胚胎率、优质胚胎数及优质胚胎率均无显著性差异(P>0.05),第2、3、4周期的正常受精率均显著提高(P<0.05),而第3周期获卵率显著低于第1、2、4周期(P<0.05)。结论4次以内的COS治疗并未明显影响卵巢储备功能及反应性。

Objective:To evaluate the impact of repeated controlled ovarian stimulation(COS)on ovarian reserve and response in assisted reproductive technology(ART).Methods:The clinical data of patients who received IVF-ET for 2-4 COS cycles in the Center of Assisted Reproductive Technology of Northwest Women’s&Children’s Hospital from January 2016 to December 2018 were analyzed retrospectively.Among them,1898 patients received 2 COS cycles(3796 cycles in total),275 patients for 3 COS cycles(825 cycles in total)and 68 patients for 4 COS cycles(272 cycles in total).They were compared in terms of basal hormone levels and change in basal antral follicle counting(AFC)after multiple cycles of COS,as well as the presence of differences in total gonadotropin(Gn)dosage,ovulation induction time,number of oocytes retrieved,oocyte retrieval rate,normal fertilization rate,number of available embryos,available embryo rate,high quality embryos,and high quality embryos rate between different treatment cycles.Results:The patient’s age gradually increased with COS cycle,while the results of the patients received different cycles of COS showed no significant differences in basal hormone levels on the 2 nd to 4 th day of menstrual cycle before ovulation induction,including the levels of FSH,LH,estradiol(E 2)and AFC(P>0.05).(1)Compared with the first COS,Gn dosage,number of oocytes retrieval,oocyte retrieval rate,normal fertilization rate,number of available embryos,available embryo rate,number of high-quality embryos,and high-quality embryo rate in the second cycle were significantly increased(P<0.05),and there was no significant difference in ovulation induction time(P>0.05).(2)Compared with the first COS,there was a significant increase in the normal fertilization rate,number of available embryos,available embryo rate,number of high-quality embryos,and high-quality embryos rate in the 2 nd and 3 rd cycle of patients undergone 3 treatment cycles(P<0.05),while there was no significant difference in Gn dosage,ovulation induction time,and number of oocytes retrieved(P>0.05).The oocyte retrieval rate was the lowest in the 2 nd cycle,and the difference was significant compared with the 1 st and 3 rd cycles(P<0.05).(3)Compared with the first COS,there were no significant differences in Gn dosage,ovulation induction time,number of oocytes retrieved,number of available embryos,available embryo rate,number of high-quality embryos,and high-quality embryo rate in the patients undergone 4 treatment cycles(P>0.05)The normal fertilization rate in the 2 nd,3 rd,4 th cycles were significantly increased(P<0.05),and the oocyte retrieval rate in the 3 rd cycle was significantly lower than that in the 1 st,2 nd,and 4 th cycles(P<0.05).Conclusions:COS treatment within 4 cycles has no obvious effects on ovarian reserve and response.