卵巢低反应患者黄体期促排卵行体外受精/卵胞质内单精子显微注射助孕临床结局分析

Clinical outcomes of luteal phase stimulation for in vitro fertilization/intracytoplasmic sperm injection treatment in poor ovarian responders

目的探讨卵巢低反应(POR)患者应用黄体期促排卵(LPS)方案行体外受精/卵胞质内单精子显微注射(IVF/ICSI)助孕的临床效果。方法收集2013年6月至2018年12月期间于河北医科大学第四医院生殖医学科应用LPS方案行IVF/ICSI助孕的134例POR患者临床资料,对其临床、实验室数据及冻融胚胎移植的临床妊娠结局进行回顾性分析。结果134例患者共行142个LPS促排卵周期,其中未取卵周期8个,占5.63%(8/142);未获卵周期11个,占7.75%(11/142);无冷冻胚胎周期占比37.32%(53/142),总周期取消率50.70%(72/142)。尿促性腺激素(hMG)使用时间是(10.04±3.51)d,用量(2330.00±890.48)IU。有24.64%(35/142)周期在扳机日孕酮降至1μg/L以下。获卵数为(3.13±2.60)枚,获卵率为76.04%(419/551);MII卵数为(2.98±2.25)枚,MII卵率为86.63%(363/419);双原核(2PN)数为(2.17±1.69)枚,2PN率为69.97%(254/363);可利用胚胎数为(2.04±1.53)枚,可利用胚胎率为91.34%(232/254);优质胚胎数为1(0.2)枚,优质胚胎率为46.06%(117/254)。2016年6月前优质胚胎冷冻后,非优质胚胎进行培养,囊胚形成率为15.22%(7/46),2016年6月后可利用胚胎全部培养,囊胚形成率为41.98%(55/131)。50例患者共行60个冻融胚胎移植周期,移植周期临床妊娠率为41.67%(25/60),流产率为44.00%(11/25),活产率为23.33%(14/60)。结论POR患者行LPS周期取消率较高,如有冷冻胚胎进行复苏移植可获得较满意临床妊娠率,但流产率较高。

Objective To explore the clinical outcomes of luteal phase stimulation(LPS)for in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)treatment in patients with poor ovarian response(POR).Methods Retrospective analysis was conducted on the clinical,laboratory data and clinical pregnancy outcome of frozen-thawed embryo transfer of 134 POR patients using LPS protocol for IVF/ICSI treatment in Reproductive Medical Center of the Fourth Hospital of Hebei Medical University from June 2013 to December 2018.Results Totally 142 IVF/ICSI cycles were completed in 134 POR patients.About 5.63%(8/142)cycles cancelled due to unsuitable follicle,7.75%(11/142)were failed to obtain oocyte and 37.32%(53/142)had unsuitable embryos for freezing,the total cancellation rate reached 50.70%.The duration of human menopausal gonadotropin(hMG)used was(10.04±3.51)d and the used dosage was(2330.00±890.48)IU.In 24.64%(35/142)cycles,progesterone decreased to less than 1μg/L on the trigger day.The number of oocytes retrieved,MII oocytes,two pronucleus(2PN),available embryos,high-quality embryos were 3.13±2.60,2.98±2.25,2.17±1.69,2.04±1.53,1(0.2),respectively.The rates of oocytes retrieved,MII oocytes,2PN,available embryos,high-quality embryos were 76.04%(419/551),86.63%(363/419),69.97%(254/363),91.34%(232/254)and 46.06%(117/254),respectively.Before June 2016,high-quality embryos were frozen,and poor-quality embryos were cultured,the blastocyst formation rate was 15.22%(7/46).After June 2016,all available embryos were cultured,the blastocyst formation rate was 41.98%(55/131).In the following frozen-thawed embryo transfer cycles,the clinical pregnancy rate per transfer cycle was 41.67%(25/60),the abortion rate was 44.00%(11/25),and the live birth rate was 23.33%(14/60).Conclusion The cancellation rate of LPS protocol was high in POR patients.If there were frozen embryos for transfer,the clinical pregnancy rate would be satisfied,but the abortion rate was high.