摘要
目的分析启动促性腺激素(Gn)前不同预处理对POSEIDON预期卵巢低反应(POR)患者体外受精(IVF)结局的影响,探索改善POR患者临床结局的策略。方法回顾性分析2016年1月至2018年5月期间就诊于北京大学第三医院妇产科生殖医学中心接受体外受精-胚胎移植(IVF-ET)的POSEIDON预期POR患者364个周期[促性腺激素释放激素(GnRH)超短激动剂/拮抗剂方案]的临床资料,按照启动Gn前的预处理情况分为短效口服避孕药(OCP)组(A组,n=167)、戊酸雌二醇组(B组,n=56)和未处理组(C组,n=141),比较3组患者的一般资料、促排卵周期指标、实验室情况及临床妊娠率等。结果A组年龄[(34.8±4.9)岁]明显小于B组[(38.0±4.9)岁]和C组[(37.9±4.7)岁](P<0.001),B组体质量指数(BMI)[(21.9±3.1)kg/m^2]明显小于A组[(23.5±3.6)kg/m^2]和C组[(23.2±3.1)kg/m^2](P=0.014),窦卵泡计数(AFC)A组(2.4±2.0)、B组(4.1±1.9)、C组(3.5±2.0)间比较差异有统计学意义(P<0.001),A组排卵障碍的比例(32.9%)明显高于B组(10.7%)和C组(11.3%)(P<0.001),C组IVF周期数(3.0±1.7)明显大于A组(2.5±1.5)(P=0.017);3组间不孕类型、不孕年限、基础卵泡刺激素(FSH)、抗苗勒管激素(AMH)值比较差异均无统计学意义(P均>0.05)。人绒毛膜促性腺激素(hCG)注射日内膜厚度A组[(9.4±1.9)mm]小于B组[(10.6±1.5)mm]和C组[(10.1±2.0)mm](P<0.001),受精率A组(77.1%)、B组(77.6%)明显高于C组(71.3%)(P=0.041);3组间Gn使用量、Gn使用时间、获卵数、卵胞质内单精子注射(ICSI)率、卵裂率、优质胚胎率、可移植胚胎数及优质胚胎数组间比较差异均无明显统计学意义(P>0.05)。着床率及临床妊娠率A组(26.2%、36.1%)和B组(26.8%、42.0%)明显高于C组(14.5%、21.2%)(P均=0.014);胚胎移植周期、移植胚胎数、囊胚移植周期比例、流产率和周期取消率组间比较差异均无统计学意义(P均>0.05)。结论启动Gn前给予OCP或黄体期戊酸雌二醇预处理均可提高POSEIDON预期POR患�
Objective To analyze the effect of different pretreatments on the in vitro fertilization(IVF)outcome of expected poor ovarian response(POR)patients according to POSEIDON criteria,and explore the appropriate treatment for POR patients.Methods A retrospective analysis of the clinical data of 364 cycles of expected POR patients who received in vitro fertilization-embryo transfer(IVF-ET)in the Center of Reproductive Medicine,Department of Obstetrics&Gynecology,Peking University Third Hospital from January 2016 to May 2018 was performed.According to the pretreatment prior to gonadotropin(Gn)stimulation,the cycles were divided into oral contraceptive(OCP)group(group A,n=167),estradiol valerate group(group B,n=56)and no pretreatment group(group C,n=141).The clinical data,ovarian stimulation indexes,laboratory status and the clinical pregnancy rate were compared among the three groups.Results The age of patients in group A[(34.8±4.9)years]was significantly younger than that of group B[(38.0±4.9)years]and group C[(37.9±4.7)years](P<0.001).The body mass index(BMI)of group B[(21.9±3.1)kg/m^2]was significantly lower than that of group A[(23.5±3.6)kg/m^2]and group C[(23.2±3.1)kg/m^2](P=0.014).There were significant differences in the antral follicle count(AFC)among group A(2.4±2.0),group B(4.1±1.9)and group C(3.5±2.0)(P<0.001).The proportion of anovulation in group A(32.9%)was significantly higher than that in group B(10.7%)and group C(11.3%)(P<0.001).The number of IVF cycles in group C(3.0±1.7)was higher than that in group A(2.5±1.5)(P=0.017).There was no significant difference in type of infertility,duration of infertility,basal follicle-stimulating hormone(FSH)and anti-Müllerian hormone(AMH)among the three groups(P>0.05).The endometrial thickness on the day of human chorionic gonadotropin(hCG)injection in group A[(9.4±1.9)mm]was thinner than that in group B[(10.6±1.5)mm]and group C[(10.1±2.0)mm](P<0.001).The fertilization rate of group A(77.1%)and group B(77.6%)was significantly higher than that of group C(7
作者
杜晓果
杨蕊
陈新娜
李蓉
王颖
李红真
Du Xiaoguo;Yang Rui;Chen Xinna;Li Rong;Wang Ying;Li Hongzhen(Center of Reproductive Medicine,Department of Obstetrics&Gynecology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2020年第7期540-546,共7页
Chinese Journal of Reproduction and Contraception
关键词
促性腺激素释放激素
超短激动剂
拮抗剂
预处理
卵巢低反应
Gonadotropin-releasing hormone
Ultrashort gonadotropin-releasing hormone agonist
Gonadotropin-releasing hormone antagonist
Pretreatment
Poor ovarian response
