摘要
目的比较卵巢储备功能减退(DOR)患者先后采用高孕激素状态下促排卵(PPOS)方案与来曲唑诱导的微刺激方案行体外受精-胚胎移植(IVF-ET)的临床效果。方法回顾性分析2018年5月至2020年12月于西安市人民医院(西安市第四医院)行微刺激方案助孕失败后,改用PPOS方案的50例DOR患者,在两种促排卵方案的药物使用、激素水平、获卵及胚胎方面的情况。结果 PPOS方案促性腺激素(Gn)使用天数与微刺激方案相似(P>0.05),但Gn总量显著高于微刺激方案(t=-4.165,P<0.01)。PPOS方案人绒毛膜促性腺激素(hCG)日的血清黄体生成素(LH)水平显著低于微刺激方案,雌二醇(E2)水平显著高于微刺激方案(t值分别为5.197、-5.554,P<0.01),孕酮(P)水平在两种方案之间差异无统计学意义(P>0.05)。PPOS方案hCG日直径≥14mm卵泡数与微刺激方案差异无统计学意义(P>0.05),PPOS方案的卵子获取数、正常受精卵数、可用胚胎数、优质胚胎数均显著高于微刺激方案(t值分别为-2.058、-3.299、-2.838、-2.514,P<0.05)。PPOS方案的正常受精率显著高于微刺激方案(χ^(2)=11.427,P<0.01),PPOS方案优质胚胎率高于微刺激方案,但差异无统计学意义(P>0.05)。微刺激方案周期取消率显著高于PPOS方案(χ^(2)=3.974,P<0.05)。结论对于DOR患者而言,PPOS方案胚胎结局较好,可作为DOR患者的优选方案。
Objective To explore the clinical effects of progestin primed ovarian stimulation(PPOS) protocol and letrozole primed mild-stimulation protocol in patients with diminished ovarian reserve(DOR) who received in vitro fertilization and embryo transfer(IVF-ET).Methods The data of 50 patients with DOR who failed to get pregnant with mild-stimulation protocol at the first cycle,and then were administrated with PPOS protocol in the next cycle in our center from May 2018 to December 2020 were analyzed retrospectively.The use of drugs,level of hormone,number of oocytes retrieved,and embryos quality were compared between the two groups.Results The duration of gonadotropin(Gn) were similar between the two protocols(P>0.05),but total dosage of Gn used with PPOS protocol were significantly more than those with mild-stimulation protocol(t=-4.165,P<0.01).The levels of luteinizing hormone(LH) on human chorionic gonadotropin(hCG) injection day were significantly lower,and estradiol(E2) levels were significantly higher in PPOS protocol compared with mild-stimulation protocol(t=5.197 and-5.554,respectively,both P<0.01),but the progesterone(P) levels were not significantly different(P>0.05).Although there was no significant difference in the number of diameter ≥14 mm follicles on the day of hCG injection between the two groups(P>0.05),the number of oocytes retrieved,the number of normal fertilization,the number of available embryos,and the number of high quality embryos were significantly increased in PPOS protocol cycles(t=-2.058,-3.299,-2.838 and-2.514,respectively,all P<0.05).The normal fertilization rate was significantly increased in PPOS protocol cycles(χ^(2)=11.427,P<0.01).The rate of high quality embryos was higher in PPOS protocol cycles,but there was no significant difference(P>0.05).The cyclical cancellation rate was significantly higher in mild-stimulation protocol(χ^(2)=3.974,P<0.05).Conclusion PPOS protocol can provide better clinical outcome for the patients with DOR.PPOS protocol provides a better option for ovulation induction.
作者
任娟
苟江
安静
赵静
REN Juan;GOU Jiang;AN Jing;ZHAO Jing(Reproductive Medicine Center,Xi'an People's Hospital,Xi'an Fourth Hospital,Shaanxi Xi'an 710004,China)
出处
《中国妇幼健康研究》
2021年第7期1042-1046,共5页
Chinese Journal of Woman and Child Health Research
基金
西安市科技计划资助项目(J201901014)
西安市人民医院(西安市第四医院)科研孵化基金课题资助项目(BS-1)。