高效孕激素下超促排卵和微刺激方案在卵巢功能减退患者中应用效果分析

Application of progestin-primed ovarian stimulation or mild stimulation protocols in patients with diminished ovarian reserve

目的探讨高效孕激素下超促排卵(PPOS)和微刺激两种方案在卵巢功能减退患者(DOR)中的促排卵效果和全胚冷冻后行冻融胚胎移植(FET)的临床妊娠结局的差异。方法对2015年12月至2016年7月在郑州大学第二附属医院行体外受精-胚胎移植(IVF-ET)辅助生殖技术的431例卵巢储备功能下降患者的资料进行回顾性分析,其中PPOS方案组209例,微刺激组222例,比较两组的促排卵实验室结局和全胚冷冻后FET的妊娠结局。采用多因素Logistic回归校正混杂因素后比较两种促排卵方案的临床妊娠率。结果 PPOS组扳机日促黄体生成素(LH)水平低于微刺激组[3.63(2.40,5.46)U/L vs.7.07(4.04,11.92)U/L,P<0.05],PPOS组取消取卵率低于微刺激组(1.44%vs.7.21%,P<0.05),PPOS组获卵数、可利用胚胎数和优质胚胎数均高于微刺激组(P<0.05)。全胚冷冻后行复苏移植,PPOS组临床妊娠率(29.17%)和胚胎着床率(14.63%)略高于微刺激组(19.70%和12.59%,P<0.05)。多因素Logistic回归分析结果显示:PPOS方案可以获得更高的临床妊娠率(OR=6.79,95%CI 1.15~40.06,P=0.035)。结论对于DOR患者,PPOS方案较微刺激方案可减少取消取卵率,并可获得更多的获卵数、可利用胚胎数和优质胚胎数,累积胚胎提供更多移植机会。PPOS方案可作为DOR患者行IVF-ET辅助生殖技术时促排卵方案的一种选择。

Objective To compare the application of progestin-primed ovarian stimulation(PPOS)with mild stimulation protocol in patients with diminished ovarian reserve(DOR)and the different clinical pregnancy outcomes of FET.Methods Retrospectively analyze 431 patients with DOR who underwent IVF-ET in the Second Affiliated Hospital of Zhengzhou University between December 2015 and July 2016,209 of whom received PPOS protocol while 222 patients received mild stimulation protocol. Comparisons of the basic information and laboratory outcome between the two groups were performed by univariable analysis. To calculate the odds ratio for clinical pregnancy adjusted for potential confounders,multivariable Logistic regression was performed.Results PPOS cycles were characterized by significantly lower level of LH in the h CG trigger day[3.63(2.40,5.46)U/L vs.7.07(4.04,11.92)U/L,P<0.05]and lower cycle cancellation rate caused by no dominant follicle growth or premature ovulation(1.44% vs. 7.21%,P<0.05),while higher oocytes retrieved and more embryos that could be used,compared with the mild stimulation group(P<0.05). The clinical pregnancy rate(29.17%) and the implantation rate(14.63%) in the PPOS group were slightly higher than those in the mild stimulation group(19.70% vs. 12.59%,P<0.05).Multivariate logistic regression analysis showed that the probability of clinical pregnancy was significantly higher in the PPOS group when compared with mild stimulation group(OR=6.79,95% CI:1.15~40.06,P=0.035),after adjusted for female age,basal FSH,type of infertility,number of transfer embryos and other variables associated with the probability of clinical pregnancy.Conclusion For DOR patients,compared with mild stimulation protocol,the PPOS protocol can reduce the cycle cancellation rate caused by no dominant follicle growth or premature ovulation,obtain more eggs,more embryos that can be used and optimal embryos to accumulate em-bryos,then to provide more transplant opportunities.PPOS protocol can offer an option for DOR patients receiving IVF-ET.