高孕激素下促排卵方案在POR患者IVF/ICSI助孕中的应用

Application of progestin primed ovarian stimulation in IVF/ICSI in poor ovarian responders

目的探讨高孕激素下促排卵方案(PPOS)与微刺激方案在卵巢低反应(POR)患者体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕中的临床效果。方法回顾性分析2018年1至10月在空军军医大学第一附属医院生殖中心行IVF/ICSI助孕的POR患者资料,共59个周期。根据临床促排卵方案的不同分为PPOS组,共34个周期;微刺激组,共25个周期。比较两组患者的基本情况、促排卵情况及实验室检查结果。结果PPOS组扳机日LH值低于微刺激组[(3.88±2.46)mIU/mL vs.(9.26±7.99)mIU/mL],t=-3.26,P<0.05;PPOS组早发LH峰率(8.82%vs.20.00%)低于微刺激组,但差异无统计学意义(P>0.05)。PPOS组可移植胚胎数[(1.59±1.54)个vs.(0.68±0.69)个]和卵子利用率(59.34%vs.32.69%)均高于微刺激组,t值分别为3.05、9.40,均P<0.05,周期取消率(29.41%vs.44.00%)低于微刺激组,但差异无统计学意义(t=1.34,P>0.05)。结论PPOS方案可有效抑制早发LH峰,一定程度上改善了卵巢的反应性,提高卵子利用率,增加可移植胚胎数,为POR患者提供了一种新的选择和希望。

Objective To observe clinical efficacy of progestin primed ovarian stimulation(PPOS) and mild ovarian stimulation protocol for poor ovarian responders(POR) undergoing IVF/ICSI.Methods The clinical data of 59 women who received IVF/ICSI cycles in our Reproductive Medicine Center from January 2018 to October 2018 were retrospectively analyzed.According to ovarian stimulation protocol,the patients were divided into PPOS protocol group(adopted in 34 ovarian stimulation cycles) and mild ovarian stimulation protocol group(adopted in 25 ovarian stimulation cycles).The basic data,ovarian stimulation and ovulation induction outcomes,and laboratory results of the patients between the two groups were compared.Results There were no statistical significance in basic data between the two groups(all P>0.05).The serum level of luteinizing hormone(LH) on human chorionic gonadotropin(HCG) injection day of the patients in PPOS group(3.88±2.46 mIU/ml) was lower than that in mild ovarian stimulation group(9.26±7.99 mIU/ml),and there was statistically significant difference( t=-3.26,P<0.05).The premature LH surge rate and cancellation rate of the patients in PPOS group were slightly lower than those in mild ovarian stimulation group(8.80% and 29.41% vs.20.00% and 44%),but there were no significant differences(t=1.34 for cancellation rate,both P>0.05).Number of transplantable embryos(1.59±1.54 vs.0.68±0.69) and utilization rate of oocytes(59.30% vs.32.70%) were higher than those in mild ovarian stimulation group(t=3.05 and 9.40 respectively,both P<0.05).Conclusion PPOS protocol can effectively control the premature LH surges and reduce cycle cancellation rate.Not only it increases the utilization rate of oocytes,but also increases the number of transplantable embryos because it improves response of the ovaries at some extend.So,PPOS protocol is an ideal treatment protocol for the poor ovarian responders.