地屈孕酮在高龄卵巢低反应患者促排卵后半程中的应用效果

Application effect of dydrogesterone in the second half of ovulation induction in the elderly patients with poor ovarian response

目的探讨地屈孕酮在高龄(≥40岁)卵巢低反应(POR)患者采用高孕激素状态下促排卵方案(PPOS)后半程中的应用效果。方法回顾性分析2018年2月至2019年2月于东莞市第三人民医院生殖医学中心接受体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子显微注射(ICSI)治疗的133例POR患者的临床资料,随机将患者分为A组(n=86)与B组(n=47)。A组给予注射用尿促性素(HMG)、枸橼酸氯米芬(CC)联合地屈孕酮,直至卵泡成熟注射注射用绒促性素(HCG),B组给予HMG和CC,促排卵后半程再添加地屈孕酮直至卵泡成熟注射HCG。比较两组患者的促排卵效果。结果两组患者HCG注射日的FSH、E2水平、≥17 mm卵泡数量比较,差异无统计学意义(P>0.05);HCG注射日,A组的LH水平显著低于B组(P<0.05)。两组提前出现LH峰的发生率、获卵数、受精率、卵裂率、可利用胚胎数量比较,差异无统计学意义(P>0.05);B组促排卵时间短于A组,Gn总量少于A组(P<0.05)。结论接受IVF-ET的高龄POR患者,采用PPOS后半程添加地屈孕酮能有效地抑制LH峰提前出现,又能改善高孕激素抑制出现的LH过低现象。

Objective To investigate the application effect of dydrogesterone in the second half of progestin primed ovarian stimulation(PPOS)in the elderly(≥40 years old)patients with poor ovarian response(POR).Methods The clinical data of 133 POR patients who received in vitro fertilization-embryo transfer(IVF-ET)or intracytoplasmic sperm microinjection(ICSI)treatment in the reproductive medicine centre of Dongguan third people's hospital from February 2018 to February 2019 were analyzed retrospectively.The patients were randomly divided into group A(n=86)and group B(n=47).The group A was given menotropins for injection(HMG),clomiphene citrate(CC)and dydrogesterone until follicular maturation,then chorionic gonadotrophin for injection(HCG)was injected,the group B was given HMG and CC,and dydrogesterone was added in the second half of ovulation induction until follicular maturation,then HCG was injected.The effects of ovulation induction were compared between the two groups.Results There were no significant differences in the levels of FSH,E2 and the number of follicles≥17 mm on the day of HCG injection between the two groups(P>0.05);on the day of HCG injection,the level of LH in the group A was significantly lower than that in the group B(P<0.05).There were no significant differences in the occurrence rate of LH peak in advance,number of retrieved oocytes,fertilization rate,cleavage rate and the number of available embryos between the two groups(P>0.05);the time of ovulation induction in the group B was shorter than that in the group A,and the total amount of Gn was less than that in the group A(P<0.05).Conclusion In the elderly POR patients who received IVF-ET,the addition of dydrogesterone in the second half of PPOS can effectively inhibit the occurrence of LH peak in advance,and improve the phenomenon of lower LH in high progesterone inhibition.