来曲唑在卵巢高反应患者促排卵中的应用

Application of letrozole in ovarian stimulation for hyper-responders

目的探讨联合使用来曲唑促排卵对卵巢高反应患者雌激素水平及妊娠结局的影响。方法回顾性分析2012年3月至2015年3月行体外受精-胚胎移植(IVF-ET)的卵巢高反应患者291例。其中使用促性腺激素释放激素拮抗剂方案促排卵患者179例,根据促排卵过程中是否使用来曲唑分为来曲唑组(n=93)和拮抗剂组(n=86);长方案组112例。比较三组患者促排卵过程中各项指标和妊娠结局。结果来曲唑组h CG注射日的平均雌二醇(E2)水平、单个大卵泡E2水平均显著地低于拮抗剂组和长方案组(P <0.05)。来曲唑组获卵数及可利用胚胎数均低于拮抗剂组及长方案组(P <0.05),但是来曲唑组的胚胎种植率、冻融胚胎移植周期临床妊娠率及活产率等优于拮抗剂组(P <0.05);三组的平均移植次数比较,差异有统计学意义(P <0.05)。来曲唑组的卵巢过度刺激综合征(OHSS)发生率最低。结论与长方案、拮抗剂方案比较,联合使用来曲唑促排卵在不影响促排卵治疗结局情况下,能有效地降低高反应患者h CG注射日E2水平及单个大卵泡E2水平。因此,来曲唑可能在雌激素依赖性肿瘤患者的促排卵治疗中有潜在的应用价值。

Objective To investigate the effect of letrozole on estradiol(E2) level and pregnancy outcome during ovarian stimulation for hyper-responders. Methods Retrospective analysis was performed on 291 women with hyper-responders who underwent in vitro fertilization-embryo transfer(IVF-ET) from March 2012 to March 2015. The ovarian stimulation protocols for IVF-ET were long protocol group(n = 112) and gonadotropin-releasing hormone antagonist(antagonist) protocol(n = 179), which were divided into letrozole group(n = 93) and antagonist group(n = 86) according to whether or not using letrozole. The indicators of stimulation parameters and pregnancy outcome in the three groups were compared. Results During the ovarian stimulation, the average E2 level and E2 level in single follicle on the hCG day in letrozole group were significantly lower than that of other two groups(P < 0.05). Although the number of oocyte retrieved and available embryos in letrozole group were significantly lower than that of long protocol group and antagonist group(P < 0.05), the implantation rate in both fresh and frozen-thaw embryo transfer(FET) cycle, clinical pregnancy rate and live birth rate in FET cycle of letrozole group were significantly higher than that of antagonist group. The average number of embryo transfer in letrozole group were significantly lower than that of antagonist group. The incidence of OHSS in letrozole group were the lowest among three groups. Conclusions Compared with long protocol group and antagonist group, letrozole could significantly decrease the E2 level and E2 level in single follicle on the hCG day for hyper-responders without affecting ovarian stimulation parameters and pregnancy outcome. Therefore, letrozole may have potential value on fertility preservation for women with estrogen-dependent cancer.