不同促排卵方案在高龄卵巢储备功能低下人群中的应用研究

Application of different ovulation stimulation protocols in patients of advanced age with diminished ovarian reserve

目的探讨不同促排卵方案在波塞冬组4即高龄卵巢储备功能低下人群中的应用效果。方法对2018年1月至2021年2月在郑州大学第二附属医院生殖医学中心接受体外受精/卵胞浆内单精子注射(IVF/ICSI)治疗的高龄卵巢储备功能低下患者的423个周期的临床资料进行回顾性分析,根据促排卵方案的不同分为高孕激素状态下促排卵(PPOS)组(A组,149个周期)、微刺激组(B组,167个周期)和拮抗剂组(C组,107个周期)。比较各组的一般资料、实验室及临床相关指标等。结果人绒毛膜促性腺激素(hCG)日黄体生成素(LH)水平及早发LH峰率A组[(4.35±2.98)U/L,5.37%(8/149)]<C组[(6.69±5.98)U/L,21.50%(23/107)]<B组[(9.52±7.79)U/L,34.73%(58/167)](均P<0.001);获卵数及可利用胚胎数(个)A组[2.53±1.71,1(1,2)]高于B组[1.89±1.91,1(0,1)](均P<0.05);每获1个卵所需费用及每获1个可利用胚胎所需费用C组[(8292.11±4849.57)元,(11716.77±4528.57)元]最高,大于A组[(5844.12±3354.69)元,(8948.35±3668.06)元](P=0.001,P<0.001)及B组[(5428.42±3031.60)元,(8334.23±3170.11)元](均P<0.001)。结论对于行IVF/ICSI治疗的35岁及以上卵巢储备功能低下的患者,PPOS方案在获得更多的获卵数及可利用胚胎数的同时,经济成本更低,是一种相对理想的促排卵方案。拮抗剂方案能够降低时间成本,可以作为对妊娠有迫切需求患者的优选。

Objective To investigate the application effect of different ovulation stimulation protocols in POSEIDEN group 4,a population with diminished ovarian reserve and elderly age.Methods A Retrospective analysis of the clinical data of 423 cycles was made,which were from patients at advanced age with diminished ovarian reserve who received IVF/ICSI in Reproduction Medicine Center of the Second Affiliated Hospital of Zhengzhou University from January 2018to February 2021.The cycles were divided into progestin-primed ovarian stimulation group(group A,149 cycles),microstimulation group(B group,167 cycles)and GnRH antagonist protocol(C group,107 cycles).The general data,laboratory results and clinical indicators of each group were compared.Results The level of LH on HCG days and the rate of early LH surge were:A group[(4.35±2.98)U/L,5.37%(8/149)]<C group[(6.69±5.98)U/L,21.50%(23/107)]<B group[(9.52±7.79)U/L,34.73%(58/167)](P<0.001,P<0.001).The number of oocytes obtained and the number of available embryos in A group[2.53±1.71,1(1,2)]were remarkably higher than those in B group[1.89±1.91,1(0,1)](P<0.05).The cost for each obtained oocyte and the cost for each available embryo in C group[(8292.11±4849.57)yuan,(11716.77±4528.57)yuan ]were higher than that in A group[(5844.12±3354.69)yuan,(8948.35±3668.06)yuan](P=0.001,P<0.001)and B group[(5428.42±3031.60)yuan,(8334.23±3170.11)yuan](P<0.001,P<0.001).Conclusions For patients over 35 with diminished ovarian reserve who accept IVF/ICSI treatment,PPOS protocol,which is a relatively ideal ovarian protocol,can get more oocytes and available embryos with lower cost.GnRH antagonist protocol can reduce the time cost and may be preferred for patients with urgent need for pregnancy.