IVF治疗中垂体降调节形成大卵泡后直接穿刺取卵的临床病例分析

Clinical cases analysis of puncturing large follicles for oocyte retrieval after pituitary down-regulation with GnRH agonist in IVF treatment

目的总结分析体外受精-胚胎移植(IVF-ET)治疗中,早卵泡期促性腺激素释放激素激动剂(GnRH-a)减量降调节后出现异常增大卵泡直接穿刺取卵体外受精的患者的临床特点,探讨实施这一治疗方法的可行性。方法回顾性分析2013年1月至2021年9月在我院辅助生殖中心接受早卵泡期GnRH-a减量降调节方案后出现异常增大卵泡(2枚及以上直径≥18 mm卵泡)同时伴有血清E_(2)升高(E_(2)>734.00 pmol/L)、未经卵巢刺激而直接穿刺取卵行IVF-ET治疗的患者资料。结果研究期间,采用早卵泡期GnRH-a减量降调节方案后出现异常增大卵泡同时伴有血清E_(2)升高,未经控制性卵巢刺激(COS)直接扳机后取卵的患者有6例。6例患者降调后出现直径≥18 mm的卵泡2~7枚不等,降调节后E_(2)水平2572.67~17616.00 pmol/L。6例患者IVF-ET后4例妊娠。4例妊娠者的扳机日单个卵泡血清E_(2)平均值为2133.96 pmol/L(1953.58 pmol/L~3523.20 pmol/L),2例未妊娠者扳机日单个卵泡血清E_(2)平均值为920.05 pmol/L(982.54 pmol/L,857.56 pmol/L)。结论早卵泡期GnRH-a降调节后若形成≥2枚大卵泡(直径≥18 mm),且单个卵泡对应的血清E_(2)平均值>1835.00 pmol/L(500.00 pg/ml)时,可尝试直接扳机后穿刺取卵行IVF-ET的治疗方案。

Objective:To summarize the clinical characteristics of patients with abnormal enlargement of follicles after down-regulation with low-dose of GnRH agonist(GnRH-a)in early follicular phase and received direct puncture for oocyte retrieval during IVF-ET,and investigate the feasibility of the novel IVF-ET strategy.Methods:The data of the patients who had abnormally enlarged follicles(≥2 follicles with diameter≥18 mm)accompanied by elevated serum E_(2)(>734.00 pmol/L)after received the down-regulation with low-dose of GnRH-a in the early follicular phase and underwent IVF-ET treatment with direct puncture for oocyte retrieval without ovarian stimulation in our reproductive center from January 2013 to September 2021 were retrospectively analyzed.Results:During the period,there were 6 patients who had abnormal follicular enlargement accompanied by elevated serum E_(2) after down-regulation with the reduced dose of GnRH-a in the early follicular stage,and received oocyte retrieval after trigger without controlled ovarian stimulation(COS).After down-regulation,6 patients had 2-7 follicles with a diameter≥18 mm,and their E_(2) levels were 2572.67-17616.00 pmol/L.Of them,four patients got pregnancy.The mean E_(2) level of single follicle on trigger day was 2133.96 pmol/L(1953.58-3523.20 pmol/L)in 4 pregnant patients and 920.05 pmol/L(982.54 pmol/L,857.56 pmol/L,respectively)in 2 unpregnant patients.Conclusions:When≥2 large ovary follicles formed after the GnRH-a down-regulation and the average E_(2) level corresponding to a single follicle was more than 1835.00 pmol/L(500.00 pg/ml),IVF-ET treatment with direct puncture for oocyte retrieval after trigger can be attempted.