卵巢储备功能减退和卵巢低反应患者应用重组人生长激素预处理对体外受精-胚胎移植治疗结局的影响

Effect of recombinant human growth hormone pretreatment on IVF-ET treatment in patients with diminished ovarian reserve and poor ovarian response

目的 探讨重组人生长激素(GH)对卵巢储备功能减退(DOR)和卵巢低反应(POR)患者在体外受精-胚胎移植(IVF-ET)周期中治疗结局的影响。方法 回顾性分析2020年1月—2021年6月在淄博市妇幼保健院生殖医学中心行IVF-ET治疗的DOR、POR不孕症患者。DOR患者分为应用GH治疗组(40个周期)和未应用GH治疗的对照组(42个周期);POR患者应用GH治疗前后进行自身对照研究(31个周期)。比较每组患者应用GH治疗后超促排卵相关参数、获卵数、受精率、优质胚胎数、优胚率、着床率及妊娠结局。结果 DOR患者GH治疗组Gn启动剂量[(270.94±54.03)U]、Gn总天数[(10.20±1.88)d]及Gn总量[(3 102.19±866.86)U]均明显少于对照组[(360.71±104.09)U、(11.02±1.85)d及(4 148.21±1 452.18)U],人绒毛膜促性腺激素(HCG)日子宫内膜厚度[(10.85±1.98)mm]显著厚于对照组[(8.60±3.76)mm],差异均有统计学意义(χ^(2)=4.87、2.00、3.98及3.42,均P<0.05)。DOR患者GH治疗组受精率(84.93%)显著高于对照组(70.14%),无可利用胚胎率(0.00%)显著低于对照组(23.81%),差异均有统计学意义(χ^(2)=13.81、8.74,均P<0.05)。POR患者GH治疗后可利用胚胎数[(2.19±1.62)个]、优质胚胎数[(1.45±1.39)个]及优质胚胎率(36.89%)均显著高于GH治疗前[(1.00±1.05)个、(0.29±0.59)个及10.47%],无可利用胚胎率(3.23%)显著低于GH治疗前(38.71%),差异均有统计学意义(χ^(2)=3.40、4.29、18.32及11.78,均P<0.05)。结论 DOR和POR患者应用GH预处理可以改善IVF-ET的治疗结局,减少周期取消率。

Objective To investigate the effect of recombinant human growth hormone(GH)on the in vitro fertilization-embryo trans⁃fer(IVF-ET)outcome of the patients with diminished ovarian reserve(DOR)and poor ovarian response(POR).Methods Retrospective analysis was performed on infertile patients with DOR,POR who received IVF-ET treatment in Reproductive Medicine Center of Zibo Mater⁃nal and Child Health Hospital from January 2020 to June 2021.Patients with DOR were divided into GH treatment group(40 cycles)and control group without GH treatment(42 cycles).Patients with POR were treated with GH and self-controlled studied were conducted(31 cycles).The parameters related to ovulation induction,the number of oocytes,fertilization rate,the number of embryo with high quality,good quality embryo rate,implanting rate and pregnancy outcomes were compared between each groups.Results The Gn starting dose[(270.94±54.03)U],total Gn days[(10.20±1.88)d]and total Gn dose[(3102.19±866.86)U]in the GH treatment group of DOR patients were significantly lower than those in the control group[(360.71±104.09)U,(11.02±1.85)d and(4148.21±1452.18)U],and the endometrial thickness of HCG days in the GH treatment group[(10.85±1.98)mm]was significantly thicker than that in the control group[(8.60±3.76)mm],and the differences were statistically significant(χ^(2)=4.87,2.00,3.98 and 3.42,P<0.05).The rate of fertilization in the GH treatment group(84.93%)was significantly higher than that in the control group(70.14%),the rate of unused embryos in the GH treatment group(0.00%)was significantly lower than that in the control group(23.81%),and the differences were statistically significant(χ^(2)=13.81,8.74,P<0.05).The number of available embryos(2.19±1.62),the number of high-quality embryos(1.45±1.39)and the rate of high-quality embryos(36.89%)in POR patients after GH treatment were significant⁃ly higher than those before GH treatment[(1.00±1.05),(0.29±0.59)and 10.47%],the rate of unused embryos(3.23%)was signif⁃icantly lower than that before GH treatment(38.71%),and the differences were statistically significant(χ^(2)=3.40,4.29,18.32及11.78,P<0.05).Conclusion GH preconditioning in patients with DOR and POR can improve the treatment outcome of IVF-ET and re⁃duce cycle cancellation rate.