疏肝法联合滋阴补肾汤治疗IVF-ET周期卵巢低反应临床研究

Clinical Study on Liver-soothing Method Combined with Ziyin Bushen Tang for Low Ovarian Response in IVF-ET Cycle

目的:疏肝法联合滋阴补肾汤对辅助生殖技术体外受精-胚胎移植(IVF-ET)周期卵巢低反应患者子宫内膜容受性、促性腺激素使用量及妊娠结局的影响。方法:将符合纳入标准的IVF-ET周期卵巢低反应患者180例按照随机分组原则,分为联合组、疏肝法组、对照组3组。对照组患者采用控制性超排卵治疗;疏肝法组患者采用疏肝法配合控制性超排卵治疗;联合组患者采用疏肝法联合滋阴补肾汤配合控制性超排卵治疗。分别对3组GnRH-a启动使用剂量、使用天数以及使用总剂量,使用人绒毛膜促性腺激素当天血清雌二醇(E2)、黄体生成素(LH)、孕酮(P)水平,子宫内膜容受性,妊娠成功率和不良妊娠结局进行对比观察。结果:3组GnRH-a启动使用剂量、使用天数、使用总剂量、使用人绒毛膜促性腺激素当天E2、P、LH水平,子宫内膜全层厚度和子宫形态之间,差异均有统计学意义(P<0.05)。经两两比较,联合组GnRH-a启动使用剂量、使用天数以及使用总剂量显著低于对照组及疏肝法组(P<0.05),联合组患者的使用人绒毛膜促性腺激素当天E2、P、LH水平和子宫内膜全层厚度显著高于对照组及疏肝法组(P<0.05),联合组临床妊娠率71.67%,高于疏肝法组51.67%及对照组41.67%(P<0.05);3组畸形、流产、早产、胎停育等情况,差异均有统计学意义(P<0.05),且联合组妊娠异常情况明显低于对照组及疏肝法组(P<0.05)。结论:疏肝法联合滋阴补肾汤对IVF-ET周期卵巢低反应患者,可有效改善患者子宫内膜容受性,降低促性腺激素使用量,提高和改善妊娠成功率和妊娠结局。

Objective:To study the effect of liver-soothing method combined with Ziyin Bushen tang on endometrial receptivity,the usage of gonadotropin and pregnancy outcome in patients with low ovarian response in the cycle of the assisted reproductive technology of in vitro fertilization-embryo transfer(IVF-ET).Methods:A total of 180 cases of patients with low ovarian response in IVF-ET cycle,who were in accordance with the inclusion criteria,were divided into the combination group,the liver-soothing method group and the control group according to the randomized principle.The control group was treated with controlled ovarian hyperstimulation;the liver-soothing method group was additionally treated with liver-soothing method based on the treatment of the control group;the combination group was additionally treated with Ziyin Bushen tang based on the treatment of the liver-soothing method group.The starting dosage,using days and total dosage of GnRH-a,the levels of estradiol(E2),luteinizing hormone(LH)and progesterone(P)in serum on the day when applying the human chorionic gonadotropin,endometrial receptivity,successful pregnancy rate and adverse pregnancy outcomes in the three groups were observed and compared.Results:Compared the starting dosage,using days and total dosage of GnRH-a,the levels of E2,P and LH in serum on the day when applying the human chorionic gonadotropin,full thickness of endometrium and uterine morphology in the three groups,there was significance in differences(P<0.05).After multiple comparison,the starting dosage,using days and total dosage of GnRH-a in the combination group were significantly lower than those in the other two groups(P<0.05);the levels of E2,P and LH in serum on the day when applying the human chorionic gonadotropin as well as the full thickness of endometrium in the combination group were significantly higher than those in the other two groups(P<0.05);the clinical pregnancy rate was 71.67%in the combination group,higher than that of51.67%in the liver-soothing method group and 41.67%in the control group(P<0.05);there were significant differences being found in malformation,abortion,premature delivery and early embryonic death in the three groups(P<0.05),and the cases of abnormal pregnancy in the combination group were much less than those in the other two groups(P<0.05).Conclusion:The therapy of liver-soothing method combined with Ziyin Bushen tang for patients with low ovarian response in IVF-ET cycle can effectively improve the endometrial receptivity,successful pregnancy rate and pregnancy outcome,and reduce the usage of gonadotropin.