卵巢低反应患者微刺激与拮抗剂方案促排卵结局和妊娠临床结局比较

Comparison of the Effects of Micro-Stimulation Scheme and Antagonist Scheme on Ovulation Induction Outcomes and Clinical Pregnancy Outcomes in Patients with Poor Ovarian Response

目的 比较卵巢低反应(POR)患者微刺激方案与拮抗剂方案的促排卵结局和妊娠临床结局。方法 选取医院2016年3月至2022年1月接受微刺激方案和拮抗剂方案的POR患者371例,取卵周期中按治疗方案不同分为微刺激组(185例)和拮抗剂组(186例)。比较两组体外授精-胚胎移植(IVF-ET)助孕过程中的促排卵结局[促性腺激素(Gn)用量、Gn使用时间、获卵总数、2PN数、可移植胚胎数、优质胚胎数]和妊娠临床结局(周期取消率、临床妊娠率、生化妊娠率、双胎率、流产率、活产率)。结果 微刺激组的抗缪勒管激素(AMH)水平、Gn用量、Gn使用时间、获卵总数、2PN数、可移植胚胎数均显著低于拮抗剂组(P <0.01)。微刺激组周期取消率为83.24%,显著高于拮抗剂组的66.67%(P <0.01)。微刺激组临床妊娠率高于拮抗剂组,但差异无统计学意义(48.39%比40.32%,P> 0.05)。结论 微刺激方案可减少POR患者Gn的用量和使用时间,临床妊娠率稍高,可能是更可行的方案。但周期取消率高,需结合患者的卵巢功能进行选择。

Objective To compare the effects of micro-stimulation and antagonist on ovulation induction outcomes and clinicalpregnancy outcomes in patients with poor ovarian response(POR).Methods A total of 371 patients with POR who received micro-stimulation and antagonist in the hospital from March 2016 to January 2022 were selected and divided into micro-stimulationgroup(185 cases) and antagonist group(186 cases) according to different treatment regimens during the ovulation cycle.Theovulation induction outcomes [amount of gonadotropins(Gn),Gn use time,total number of harvest eggs,number of 2PN,number oftransplantable embryos,and number of high-quality embryos] and clinical pregnancy outcomes(cycle cancellation rate,clinicalpregnancy rate,biochemical pregnancy rate,twin rate,abortion rate,and live birth rate) during in vitro fertilization-embryotransfer(IVF-ET) assisted pregnancy were compared between the two groups.Results The anti-mullerian hormone(AMH),the amount of Gn and Gn use time,total number of harvest eggs,number of 2PN,and number of transplantable embryos in themicro-stimulation group were significantly lower than those in the antagonist group(P < 0.01).The cycle cancellation rate inthe micro-stimulation group was 83.24%,which was significantly higher than 66.67% in the antagonist group(P < 0.01).Theclinical pregnancy rate in the mioro-stimulation group was lower than that in the antagonist group,without significant difference(48.39% vs.40.32%,P > 0.05).Conclusion Micro-stimulation can reduce the dosage and duration of Gn in patients withPOR,with a slightly higher clinical pregnancy rate,which may be a more feasible plan.However,the cancellation rate of the cycleis high,and the selection needs to be based on the patient′s ovarian function.