摘要
目的 探讨拮抗剂、卵泡期高孕激素及黄体期促排方案在卵巢低反应患者的临床疗效.方法 回顾性分析2016年10月-2018年3月期间在本院接受体外受精-胚胎移植(IVF-ET)治疗的卵巢低反应(DOR)患者,共198例.根据促排方案不同分为拮抗剂方案71例(A组),卵泡期高孕激素(PPOS)方案组53例(B组),黄体期促排方案74例(C组).比较三组促排方案患者的累积妊娠率及妊娠时间(TTP)和费效比观察.结果 三组DOR患者的年龄、体重指数(BMI)、AMH、基础FSH、LH、E2、AFC等基本资料是一致的.三组患者促排周期的Gn总量(2407.57±927.30;2356.60±892.41;2288.05±742.03)、Gn天数(9.49±2.24;10.32±2.56;9.95±2.38)、HCG日E2值差异无统计学意义(P>0.05);HCG日LH值(5.50±5.17;4.13±2.25;4.22±2.84)三组间差异有统计学意义(P<0.05),拮抗剂组LH值高;但患者的获卵数(3.00±2.07;2.98±2.10;2.78±2.22)、MII卵数(2.32±1.94;2.32±2.15;2.58±2.07)、优质胚胎数(0.52±0.79;0.81±0.94;0.66±0.98)组间差异均无统计学意义(P>0.05).周期取消率、累积临床妊娠率均无差异(P>0.05).故拟新鲜胚胎移植的患者应选择拮抗剂方案,其妊娠时间短,取卵后3 d即可移植;费效比低,无冷冻和复苏产生费用.拟冻胚移植患者应选择PPOS方案或黄体期促排方案,三种方案妊娠时间无差异,但B、C组费效比低,因促排周期无需使用GnRH-A而产生较高的促排费用.结论 在DOR患者中,拟新鲜胚胎移植的患者应选择拮抗剂方案,其妊娠时间短,费效比低;拟冻胚移植患者应选择PPOS方案或黄体期促排方案,费效比低.
Objective To compare the clinical efficacy of Gonadotropin-releasing hormone antagonist(GnRH-A)protocol,progestin primed ovarian stimulation(PPOS)protocol and luteal-phase ovarian stimulation protocol in the patients with decreased ovarian responsiveness(DOR).Methods A retrospective analysis was performed in 198 infertile patients with DOR after in vitro fertilization-embryo transfer(IVF-ET)in our hospital from October 2016 to March 2018,and clinical outcomes,pregnancy time and costs were compared.According to different protocols,patients were divided into three groups including group A(GnRH-A protocol,71 cases),group B(PPOS protocol,53 cases)and group C(luteal-phase ovarian stimulation protocol,74 cases).Clinical outcomes,pregnancy time and the cost-effective ratio were compared in three kinds of protocols.Results The age of patients,body mass index(BMI),AMH,basic FSH,LH,E2 level,AFC were similar in the three groups.The total Gn values(2407.57milar i;2356.60milar i;2288.05milar i),the number of Gn days(9.49 numb;10.32 numb;9.952 numb and E2 value at HCG day were not significant difference in three groups(P>0.05).The LH of antagonist group was higher in the HCG day than that in the other groups which was significant different.But the number of acquired eggs(3.00±2.07;2.98the n;2.78the n),the number of MII eggs(2.32e num;2.32e num;2.58e num)and the number of high quality embryos(0.52the n;0.81the n;0.66the n)were similar(P>0.05)in three groups.There was no difference in cancellation rate and cumulative clinical pregnancy rate(P>0.05).Therefore,the patients who have been prepared for the fresh embryo transfer should choose the antagonist protocol,which has short time to pregnancy and will be quickly transplanted after ovarian puncture.The cost is low because of no freezing and thawing.The PPOS protocol or luteal-phase ovarian stimulation protocol should be selected for the patients with frozen embryo transfer.Pregnancy time was no difference between the three groups,but the cost of group B and C was low,because Gn
作者
田海清
张萌
腊晓琳
TIAN Haiqing;ZHANG Meng;LA Xiaolin(Department of Reproductive Center,The First Affiliate Hospital of Xinjiang Medical University,Urumqi,830054,China)
出处
《新疆医学》
2019年第4期332-335,353,共5页
Xinjiang Medical Journal
基金
新疆维吾尔自治区厅局级项目(项目编号:TG201507)
吴阶平医学基金会临床科研专项资助基金(课题编号:320.6750.16187)
关键词
拮抗剂方案
卵泡期高孕激素方案
黄体期促排方案
卵巢低反应
Gonadotropin-releasing hormone antagonist(GnRH-A)protocol
progestin primed ovarian stimulation(PPOS)protocol
luteal-phase ovarian stimulation protocol
Decreased ovarian responsiveness(DOR)
