补肾促排卵汤对反复移植失败患者卵子质量及体外受精-胚胎移植妊娠结局的影响

Effects of Bushen ovulation⁃stimulating decoction on oocyte quality and pregnancy outcome of IVF⁃ET in patients with repeated transplantation failure

目的 探讨补肾促排卵汤对反复移植失败患者卵子质量及妊娠结局的影响。方法 选取2019年1月至2021年1月于晋中婴泰妇产医院生殖医学科因反复移植失败再次接受体外受精-胚胎移植(IVF-ET)治疗的86例患者作为研究对象,按随机数字表法分为对照组和观察组,每组各43例,对照组在IVF-ET治疗前2 d采用黄体酮治疗,观察组在对照组基础上于移植前月经周期黄体生成素峰值时联用补肾促排卵汤治疗,2组患者连续用药3个月经周期,观察并对比2组患者中医症状评分、激素水平、卵子质量、子宫内膜及血流情况。结果 治疗3个月经周期后观察组经色暗淡、腰膝酸软、阴道干涩各项中医症候评分低于对照组(P<0.05);移植后第3周,观察组血清孕酮(P)和雌二醇(E_2)水平高于对照组(P<0.05),卵泡刺激素(FSH)水平低于对照组(P<0.05);排卵日观察组子宫内膜厚度厚于对照组(P<0.05),子宫动脉阻力指数(RI)和搏动指数(PI)低于对照组(P<0.05);观察组受精率高于对照组,平均获得卵子数多于对照组(P<0.05);观察组临床妊娠率、分娩孕周、新生儿体重、新生儿1 min Apgar评分高于对照组(P<0.05),早期流产率和早产率低于对照组(P<0.05)。结论 补肾促排卵汤能改善反复移植失败再次接受IVF-ET治疗患者的中医症候评分,促进子宫血流循环,提高性激素水平及卵子质量,从而降低妊娠不良结局发生率。

Objective To explore the effects of Bushen ovulation‐stimulating decoction on oocyte quality and pregnancy outcome of in vitro fertilization‐embryo transfer(IVF‐ET)in patients with repeated transplantation failure.Methods From January 2019 to January 2021,86 patients who received IVF‐ET again because of repeated transplantation failure in Jinzhong Yingtai Women’s&Children’s Hospital were randomly divided into control group and observation group,with 43 cases in each group.Progesterone was given 2 days before IVF‐ET treatment in both groups,and the observation group was additionally treated with Bushen ovulation‐stimulating decoction at the peak of luteinizing hormone in menstrual cycle before transplantation.All the patients in both groups were treated continuously for 3 menstrual cycles.Traditional Chinese medicine symptom score,hormone level,oocyte quality,endometrium and blood flow were observed and compared between the 2 groups.Results After 3 menstrual cycles of treatment,the scores of pale menstrual color,soreness and softness of waist and knees,and dryness in the vagina in the observation group were significantly lower than those in the control group(P<0.05).Three weeks after transplant,the observation group had significantly higher levels of serum progesterone(P)and estradiol(E2)and lower level of follicle stimulating hormone(FSH)than the control group(all P<0.05).On the day of ovulation,the thickness of endometrium in the observation group was significantly higher than that in the control group,and the resistance index(RI)and pulsatility index(PI)of uterine artery in the observation group were significantly lower than those in the control group(P<0.05).The fertilization rate,the number of ovum obtained,clinical pregnancy rate,average gestational weeks of delivery,neonatal weight and one‐minute Apgar score in the observation group were significantly higher than those in the control group(P<0.05).The early abortion rate and fetal preterm birth rate in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Bushen ovulation‐stimulating decoction can significantly increase the scores of traditional Chinese medicine symptoms,improve blood circulation of uterus,gonadal hormone concentrations and oocyte quality,and reduce the incidence of adverse pregnancy outcomes in patients who repeatedly fail to receive IVF‐ET treatment.