预期卵巢低反应患者不同促排卵方案的结局分析

doi:10.12280/gjszjk.20210346

摘要/Abstract

摘要：

目的： 比较拮抗剂方案、微刺激方案及高孕激素状态下促排卵（PPOS）方案在预期卵巢低反应（POR）患者中的应用效果。方法： 选取2016年1月—2020年12月于安徽医科大学附属妇幼保健院行体外受精（IVF）/卵细胞质内单精子注射（ICSI）助孕的预期POR患者为研究对象,按促排卵方案分为拮抗剂组（A组,161个周期）、微刺激组（B组,300个周期）和PPOS组（C组,153个周期）,分析3组促排卵结局。由于C组方案对子宫内膜容受性有影响,未进行鲜胚移植,且A组、B组鲜胚移植周期少,故仅收集3组方案行冻融胚胎移植（FET）周期（A组120个周期,B组114个周期,C组65个周期）的临床结局。结果： A组患者促性腺激素（Gn）用量高于B组及C组,B组Gn时间比A组少（均P<0.05）。A组获卵数最多,B组次之,C组最少,差异有统计学意义（均P<0.05）。A组MⅡ卵数多于B组和C组（均P<0.05）。C组的周期取消率大于A组和B组（P<0.05）。3组患者可用胚胎数、优质胚胎数、受精率和卵裂率比较,差异均无统计学意义（P>0.05）。3组行FET患者的着床率、临床妊娠率比较,差异无统计学意义（均P>0.05）。结论： 与拮抗剂方案相比,微刺激方案Gn用量及Gn时间少;与PPOS方案比,微刺激方案具有更低的周期取消率。3种方案获胚胎后行FET周期的结局相似,微刺激方案对于预期POR患者是更适合的促排卵方案。

关键词: 排卵诱导, 体外受精, 精子注射,细胞质内, 卵巢低反应, 微刺激方案, 拮抗剂方案, 高孕激素状态下促排卵方案

Abstract:

Objective: To compare the clinical outcomes of antagonist, microstimulation and progestin-primed ovarian stimulation (PPOS) protocols in the patients with expected poor ovarian response (POR). Methods: The expected PORs who underwent in vitro fertilization (IVF)/intra cytoplasmic sperm injection (ICSI) treatment in Maternal and Child Health Hospital Affiliated to Anhui Medical University from January 2016 to December 2020 were selected and divided into 3 groups: antagonist group (group A, 161 cycles), microstimulation group (group B, 300 cycles) and PPOS group (group C, 153 cycles). The ovulation induction outcomes of the three groups were analyzed. Due to the influence on endometrial receptivity in group C and the few fresh embryo transfer cycles in group A and B, only the clinical outcomes of the frozen-thawed embryo transfer (FET) cycles (120 cycles in group A, 114 cycles in group B, 65 cycles in group C) were collected. Results: The amount of gonadotrophin (Gn) in group A was higher than that in group B or group C, the number of Gn days was shorter in the group B than group A (both P<0.05). The number of oocytes retrieved in group A was more than group B or group C, and this number in group B was in the middle (P<0.05). The number of mature oocytes (MⅡ) in group A was more than that in group B or group C (P<0.05). The cycle cancellation rate in group C was higher than that in group A or group B (P<0.05). However, there were no significant differences in the number of available embryos, the number of high-quality embryos, fertilization rate, cleavage rate, implantation rate and clinical pregnancy rate of FET among the three groups (all P>0.05). Conclusions: Compared with the antagonist program, the microstimulation program has less Gn amount and shorter time. Compared with the PPOS program, the microstimulation program has a lower cycle cancellation rate. The clinical outcomes of the FET cycle in the three programs were similar. The microstimulation program is more suitable for those patients with expected POR.

Key words: Ovulation induction, Fertilization in vitro, Sperm injections,intracytoplasmic, Poor ovarian response, Minimal stimulation protocol, Antagonist protocol, Progestin-primed ovarian stimulation protocol

李婉晴, 洪名云, 唐志霞. 预期卵巢低反应患者不同促排卵方案的结局分析[J]. 国际生殖健康/计划生育, 2022, 41(1): 1-5.

LI Wan-qing, HONG Ming-yun, TANG Zhi-xia. Clinical Study of Different Ovulation Induction Schemes in the Treatment of Patients with Expected Poor Ovarian Response[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(1): 1-5.

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参考文献 23

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组别	周期	年龄（岁）	不孕时间（年）	BMI（kg/m²）	AMH（ng/mL）	基础FSH（U/L）
A组	161	37.61±5.73	3.0（1.0,6.0）	22.84±2.82	0.58±0.30	11.69±6.47
B组	300	38.55±5.46	3.0（1.0,7.0）	22.98±2.76	0.54±0.31	11.96±6.62
C组	153	37.62±6.07	3.0（1.0,7.5）	22.51±2.74	0.51±0.30	13.02±6.47
F或χ²		2.087	0.019	1.435	1.736	1.885
P		0.125	0.991	0.239	0.177	0.153

组别	周期	年龄（岁）	不孕时间（年）	BMI（kg/m²）	AMH（ng/mL）	基础FSH（U/L）
A组	161	37.61±5.73	3.0（1.0,6.0）	22.84±2.82	0.58±0.30	11.69±6.47
B组	300	38.55±5.46	3.0（1.0,7.0）	22.98±2.76	0.54±0.31	11.96±6.62
C组	153	37.62±6.07	3.0（1.0,7.5）	22.51±2.74	0.51±0.30	13.02±6.47
F或χ²		2.087	0.019	1.435	1.736	1.885
P		0.125	0.991	0.239	0.177	0.153

组别	周期	Gn用量（IU）	Gn时间（d）	获卵数（个）	MⅡ卵数（个）	可用胚胎数（个）	优质胚胎数（个）	受精率	卵裂率	周期取消率
A组	161	2 238.66±799.97	7.94±2.28	2.41±1.36	2（1,2）	1（1,2）	1（0,1）	77.90（289/371）	92.73（268/289）	21.74（35/161）
B组	300	1 240.58±537.71*	7.21±2.45*	1.80±1.04*	1（0,2）*	1（1,2）	1（0,1）	75.76（400/528）	94.00（376/400）	22.67（68/300）
C组	153	1 359.35±685.34*	7.67±3.07	1.53±1.16*^△	1（0,2）*	1（1,1）	1（0,1）	77.62（163/210）	92.02（150/163）	32.68（50/153）*^△
F或 χ²		129.647	4.672	22.794	32.859	3.333	1.028	0.652	0.858	6.609
P		0.000	0.010	0.000	<0.001	0.189	0.598	0.722	0.651	0.037

组别	周期	Gn用量（IU）	Gn时间（d）	获卵数（个）	MⅡ卵数（个）	可用胚胎数（个）	优质胚胎数（个）	受精率	卵裂率	周期取消率
A组	161	2 238.66±799.97	7.94±2.28	2.41±1.36	2（1,2）	1（1,2）	1（0,1）	77.90（289/371）	92.73（268/289）	21.74（35/161）
B组	300	1 240.58±537.71*	7.21±2.45*	1.80±1.04*	1（0,2）*	1（1,2）	1（0,1）	75.76（400/528）	94.00（376/400）	22.67（68/300）
C组	153	1 359.35±685.34*	7.67±3.07	1.53±1.16*^△	1（0,2）*	1（1,1）	1（0,1）	77.62（163/210）	92.02（150/163）	32.68（50/153）*^△
F或 χ²		129.647	4.672	22.794	32.859	3.333	1.028	0.652	0.858	6.609
P		0.000	0.010	0.000	<0.001	0.189	0.598	0.722	0.651	0.037

组别	周期	年龄（岁）	BMI （kg/m²）	子宫内膜厚度（mm）	移植胚胎数（个）	优质胚胎移植
A组	120	37.93±5.38	23.32±3.56	10.12±2.14	1.43±0.51	95（79.17）
B组	114	38.79±5.65	23.25±2.61	9.94±2.02	1.39±0.51	91（79.82）
C组	65	38.09±5.70	22.73±2.71	9.85±2.42	1.48±0.53	49（75.38）
F或 χ²		0.750	0.860	0.371	0.650	0.524
P		0.473	0.424	0.690	0.523	0.770