醋酸甲羟孕酮在卵巢储备功能减退患者IVF/ICSI-ET助孕中的应用分析

Application of medroxyprogesterone acetate in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer for women with diminished ovarian reserve

目的:探讨卵巢储备功能减退患者体外受精/卵泡浆内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)促排卵过程中应用醋酸甲羟孕酮对结局的影响。方法:IVF/ICSI-ET助孕的72例卵巢储备功能减退患者分为对照组、观察组;对照组采用超短方案,观察组采用醋酸甲羟孕酮联合注射用尿促性素(human menopausal gonadotropin,HMG)促排卵,分析观察组促排卵过程中黄体生成素(luteinizing hormone,LH)水平的变化,比较两组患者的获卵数、成熟卵数、优质胚胎数等的差异。结果:观察组在促排卵过程中未监测到LH峰,“观察组、对照组间获卵数(3.31±1.26比3.11±1.21,P>0.05)、MⅡ卵数(3.17±1.16比2.97±1.16,P>0.05)和第3 d后优质胚胎数(2.25±0.87比2.14±1.02,P>0.05)比较差异均无统计学意义。”;观察组MC(7~9)d、MC(10~12)d及扳机日的LH水平均明显低于对照组(P<0.05),两组间孕酮水平比较无差别(P>0.05)。结论:醋酸甲羟孕酮能有效抑制LH峰,与HMG联合应用于卵巢储备功能减退患者能达到较好的促排卵效果,可作为一种备选方法。

Objective:To investigate the effect of medroxyprogesterone acetate for ovulation induction on the outcome of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)in patients with diminished ovarian reserve(DOR).Methods:A total of 72 patients with DOR who underwent IVF/ICSI-ET to promote pregnancy were divided into control group and observation group.The patients in the control group received the ultra-short protocol,and those in the observation group received medroxyprogesterone acetate combined with human menopausal gonadotropin(HMG)for ovulation induction.The change in the level of luteinizing hormone(LH)during ovulation induction was observed,and the two groups were compared in terms of the number of retrieved oocytes,the number of mature oocytes,and the number of high-quality embryos.Results:No LH surges were detected during ovulation induction in the observation group,and there were no significant differences between the observation group and the control group in the number of retrieved oocytes(3.31 ± 1.26 vs 3.11 ± 1.21,P > 0.05).The number of MⅡ oocytes(3.17 ± 1.16 vs 2.97 ± 1.16,P > 0.05),and the number of high-quality embryos on day 3(2.25 ± 0.87 vs 2.14 ± 1.02,P > 0.05).Compared with the control group,the observation group had a significantly lower level of LH on MC(7 ~ 9)day,MC(10 ~ 12)day,and trigger day(P < 0.05).There was no significant difference in the level of progesterone between the two groups(P > 0.05).Conclusion:The use of medroxyprogesterone acetate is an effective method to inhibit premature LH surges,and its combination with HMG can achieve a good effect of ovulation induction in patients with DOR and is thus an alternative treatment method.