摘要
【目的】比较卵巢低反应患者进行卵巢轻微刺激和控制性卵巢刺激体外受精-胚胎移植(IVF-ET)周期中卵泡液内激素水平、细胞因子的差异及其与获卵数、胚胎数等的关系。【方法】本研究为观察性研究。招募符合博洛尼亚标准的卵巢低反应患者,随机分为实验组(组2)和对照组(组1)。实验组采用来曲唑及低剂量外源性促卵泡生成素(Gn)进行卵巢轻微刺激,对照组采用常规控制性卵巢刺激(黄体期GnRH激动剂修饰长方案)进行卵巢刺激。于取卵日收集成熟卵泡(>16 mm)的卵泡液,其中实验组共23例,对照组共28例,测量卵泡液中促卵泡生成素(FSH)、促黄体生成素(LH)、雌激素(E2)、孕激素(P)、睾酮(T)和抗苗勒管激素(AMH)水平,以及抑制素(inhibin)、生长分化因子9(GDF9)和骨形成蛋白家族(BMP)水平。统计分析卵泡液中各激素、因子水平与获卵数、可利用胚胎数及优质胚胎数的相关性。【结果】实验组和对照组患者基本情况各指标之间:年龄、不孕年限、基础FSH、和窦卵泡数(AFC)差异均无显著性意义(P>0.05)。与对照组相比,实验组Gn用量更少,但两组的获卵数,可利用胚胎数及优质胚胎数差异均无统计学意义(P>0.05)。与对照组相比,实验组卵泡液中LH水平、睾酮水平和inhibin B水平明显增高,而FSH水平、inhibin A水平、BMP8B和GDF9水平明显降低。其他几种激素水平,包括E2、P、AMH和BMP2、6、8B、15水平,两组间差异无显著性意义(P>0.05)。相关分析显示,卵泡液中各激素和细胞因子水平均与获卵数、可移植胚胎数及优质胚胎数无相关性。【结论】POR患者使用不同的轻微刺激和常规控制性卵巢刺激,卵泡微环境不同。但未发现这些变化与获卵数、可利用胚胎数、优质胚胎数存在相关性。
【Objective】To compare the hormonal milieu of follicular fluid from pre-ovulatory follicles between mild stimulation and controlled ovarian hyperstimulation(COH)in-vitro fertilization(IVF)cycles in poor ovarian response(POR)patients.【Methods】From August to November 2014,follicular fluid was prospectively collected from 51 POR patients undergoing IVF treatment stimulated with mild stimulation(n=23)or COH(GnRH agonist long“stop”protocol,n=28),Follicular fluid(FF)was collected from one follicle larger than 16 mm and intra-follicular FSH,LH,estradiol(E2),progesterone(P),testosterone(T)and anti-mullerian hormone(AMH)levels were assayed.The differences in FF hormonal profile between two groups were compared and the correlation between each identical hormonal level and num-ber of oocytes retrieved,transferrable embryos or good-quality embryos was evaluated.【Results】The differences in basic characteristics,such as age,AFC,basal FSH,E2,LH and AMH levels between two groups had no statistical signifi-cant meaning.The dose of Gn consumption was significantly higher in COH group,while the number of oocyte re-trieved,transferrable embryo and good quality embryo were same in two groups.Comparing with COH group,the FF LH and T levels were significantly higher,while the FSH,inhibin A,BMP 8B and GDF 9 level were significantly lower in mild stimulation group.No significant difference was observed in other hormones,including E2,P,AMH and BMP2/6/8A/15.None of these hormones was found to be correlated with the number of oocyte retrieved,transferrable embryos,or good quality embryos(all with P>0.05).【Conclusions】Comparing with COH group,the intra-follicular LH,T and inhibin B were significantly higher,while FSH level was lower in mild stimulation group.No significant difference was observed in E2,P,AMH and BMP2/6/8A/15 levels between two groups.The distinction of intra-follicular hormone profiles indicated that follicular microenvironment was varied between mild stimulation and COH,which might conse-quently have impa
作者
李婷婷
张晓莉
黄睿
LI Ting-ting;ZHANG Xiao-li;HUANG Rui(Reproductive Medicine Research Center,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)
出处
《中山大学学报（医学版）》
CAS
CSCD
北大核心
2018年第5期736-741,共6页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省医学科学基金(A2015025)
国家重点研发计划"生殖健康及重大出生缺陷防控研究"重点专项课题(2016YFC1000302)
关键词
卵巢轻微刺激
卵巢低反应
卵泡液微环境
mild stimulation
poor ovarian response
hormonal profile of follicular fluid
