微刺激方案与低剂量Gn方案在卵巢功能减退患者的促排卵效果比较

Comparison of pregnancy outcome of two kinds of mild stimulation protocol and low dose gonadotropin ovulation stimulation protocol in IVF patients

目的:比较来曲唑(LE)微刺激方案和克罗米芬(CC)微刺激方案与低剂量促性腺激素(Gn)促排卵方案对卵巢储备功能减退患者接受体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾分析2016~2017年于山东大学附属生殖医院接受IVF治疗的卵巢储备功能减退患者的299个周期的资料,其中LE微刺激组105个周期,CC微刺激组130个周期,Gn组64个周期,比较3组的IVF-ET结局。结果LE微刺激组的HCG日雌激素水平低于CC微刺激组和Gn组(292.83±191.96)pg/ml vs(1024.00±560.39)pg/ml、(937.62±937.84)pg/ml,(P<0.05);CC微刺激组HCG日内膜厚度薄于LE微刺激组和Gn组(0.63±0.19)cm vs(0.90±0.19)cm、(0.92±0.22)cm,(P<0.05);LE微刺激组的妊娠率高于Gn组(41.38%vs 16.00%,P<0.05),与CC微刺激组比较无差异(41.38%vs 26.19%,P>0.05)。3组的Gn天数、Gn总量、获卵数、优胚数、着床率、活产率、累积妊娠率、累积活产率比较,差异均无统计学意义。结论微刺激方案与低剂量Gn促排卵方案相比可获得相似促排卵效果,LE可能对改善临床结局有一定作用。

Objective:To compare the influence of mild stimulation protocol with letrozole(LE)or clomiphene(CC)with low dose gonadotropin(Gn)ovulation stimulation protocol to the pregnancy outcome of in vitro fertilization-embryo transfer(IVF-ET)patients which have diminished ovarian reserve(DOR).Methods:The data of 299 cycles,including 105 LE cycles,130 CC cycles and 64 Gn cycles,that received IVF-ET treatment at Reproductive Hospital Affiliated to Shandong University in 2016~2017 were analyzed by retrospective analysis to compare the pregnancy outcome.Result:Compared with CC group and Gn group,significantly lower serum estrogen level on day of human chorionic gonadotropin(HCG)administration[(292.83±191.96)pg/ml vs(1024.00±560.39)pg/ml、(937.62±937.84)pg/ml,P<0.05]were observed in mild stimulation group.The endometrial thickness on day of HCG administration,CC group was significantly thinner than LE and Gn group[(0.63±0.19)cm vs(0.90±0.19)cm、(0.92±0.22)cm,P<0.05],but no significant difference was found between LE group and Gn group.The pregnancy rate of LE group were marked higher than Gn group(41.38%vs 16.00%,P<0.05),but no significant difference was found between CC group.No statistically significant difference was found in the three groups in duration of Gn,total doses of Gn,number of oocytes retrieved,the number of high-quality embryo,implantation rate,live birth rate,cumulative pregnancy rate,cumulative live birth rate.Conclusion:In the patients with decreasing ovarian reserve,similar clinical effects were observed between mild stimulation protocol and low dose Gn ovulation stimulation protocol.Notably,LE may be in favor of clinical outcomes.