自拟养卵方对IVF-ET中肾虚血瘀型卵巢储备功能下降患者的临床疗效观察

Effect of self-made ovary-nourishing prescription on patients with diminished ovarian reserve with kidney deficiency and blood stasis during in vitro fertilization-embryo transfer

目的:观察自拟养卵方对体外受精-胚胎移植(IVF-ET)中肾虚血瘀型卵巢储备功能下降(DOR)患者的影响。方法:纳入准备进行IVF-ET的肾虚血瘀型DOR患者120例,采用随机数字表法分为治疗组和对照组,每组各60例。治疗组予自拟养卵方治疗,对照组予芬吗通治疗,疗程均为3个月经周期。治疗结束后,2组患者均进入IVF-ET周期。比较2组治疗前后的中医证候积分,血清基础卵泡刺激素(FSH)、黄体生成素(LH)水平,FSH/LH值,血清雌二醇(E_(2))、抗苗勒管激素(AMH)水平,窦卵泡数(AFC);在IVF-ET周期中,比较2组促性腺激素(Gn)用量及使用天数、获卵数、受精率、总胚胎数、优质胚胎数、优质胚胎率、周期取消率、临床妊娠率以及早期流产率。结果:2组中医证候积分、FSH、LH、FSH/LH、E_(2)、AMH、AFC治疗前后组内比较及治疗后组间比较,差异均有统计学意义(P<0.05)。治疗组患者Gn用量及使用天数均少于对照组,获卵数、总胚胎数、优质胚胎数多于对照组,优质胚胎率高于对照组,差异均有统计学意义(P<0.05)。结论:自拟养卵方能够显著改善肾虚血瘀型DOR患者的卵巢储备功能,有效提高IVF-ET中的卵巢反应性,从而改善IVF-ET的临床结局。

Objective: To investigate the effect of self-made ovary-nourishing prescription on patients with diminished ovarian reserve(DOR) with kidney deficiency and blood stasis during in vitro fertilization-embryo transfer(IVF-ET).Methods: A total of 120 DOR patients with kidney deficiency and blood stasis who planned to undergo IVF-ET were divided into treatment group and control group using a random number table, with 60 patients in each group.The patients in the treatment group were given self-made ovary-nourishing prescription, and those in the control group were given Femoston, with a treatment course of 3 menstrual cycles for both groups.All patients entered the IVF-ET cycle after treatment.The two groups were compared in terms of traditional Chinese medicine(TCM) syndrome score, serum levels of follicle-stimulating hormone(FSH) and luteinizing hormone(LH),FSH/LH ratio, serum levels of estradiol(E_(2)) and anti-mullerian hormone(AMH),and antral follicle count(AFC) before and after treatment;in the IVF-ET cycle, the two groups were compared in terms of the amount of gonadotropin(Gn) used, the number of days of Gn application, number of retrieved oocytes, fertilization rate, total number of embryos, number of high-quality embryos, high-quality embryo rate, cycle cancellation rate, clinical pregnancy rate, and early miscarriage rate.Results: Both groups had significant changes in TCM syndrome score, FSH,LH,FSH/LH ratio, E_(2),AMH,and AFC after treatment, and there were significant differences in these indices between the two groups after treatment(P<0.05).Compared with the control group, the treatment group had significantly lower amount of Gn used and number of days of Gn application and significantly higher number of retrieved oocytes, total number of embryos, and number of high-quality embryos, as well as a significantly higher high-quality embryo rate(P<0.05).Conclusion: Self-made ovary-nourishing prescription can significantly improve ovarian reserve function in DOR patients with kidney deficiency and blood stasis and effectively increase ovarian response during IVF-ET,thereby improving the clinical outcome of IVF-ET.