摘要
目的探讨高孕激素下促排卵(PPOS)方案在卵巢高反应人群中的应用效果。方法选取2019年2月至2020年8月在嘉兴市妇幼保健院生殖医学中心行体外受精/卵胞质内单精子显微注射助孕的卵巢高反应患者84例,采用随机数字表法分为PPOS组42例和拮抗剂组42例,比较两组患者促排卵情况、胚胎实验室结局以及冻融胚移植临床结局。结果PPOS组患者早发黄体生成素(LH)峰发生率、获卵数和减数第二次分裂中期(MⅡ)卵数均低于拮抗剂组,两原核(2PN)受精率高于拮抗剂组,差异均有统计学意义(均P<0.05);而两组患者促性腺激素(Gn)天数、Gn用量、人绒毛膜膜促性腺激素(hCG)日直径≥14 mm卵泡数、hCG日雌二醇、hCG日孕酮、hCG日LH水平、中重度卵巢过度刺激综合征(OHSS)发生率、受精方式、2PN受精数、可移植胚胎数、优胚数、MⅡ卵率、2PN卵裂率、优胚率及冻融胚胎移植生化妊娠率、临床妊娠率、胚胎种植率、早期流产率、异位妊娠率、持续妊娠率比较差异均无统计学意义(均P>0.05)。结论与拮抗剂方案相比,PPOS方案应用于卵巢高反应患者能有效抑制早发LH峰,降低卵巢高反应患者OHSS的发生率,且不影响卵母细胞的发育潜能和胚胎的质量,获得较好的临床妊娠结局。
Objective To explore the efficacy of progestin primed ovarian stimulation(PPOS)protocol in high ovarian responders.Methods Eight-four patients,who underwent in vitro fertilization/intracytoplasmic sperm injection at the Reproductive Center of Jiaxing Municipal Maternal and Child Health Hospital From February 2019 to August 2020,were randomly assigned to receive treatment with either PPOS protocol(n=42)or gonadotropin-releasing hormone antagonists(GnRH-A)pro-tocol(n=42).The basic information,process of controlled ovarian stimulation,laboratory outcomes of the embryos and clinical outcomes of frozen-thawed embryo transfer were compared between the two groups.Results The premature luteinizing hormone(LH)surge rate,number of oocytes retrieved,number of mature oocytes in PPOS group were lower than those in GnRH-A group,the 2PN fertilization rate in PPOS group was higher than that in GnRH-A group(all P<0.05).There were no statistical differences between two groups in gonadotropin(Gn)days,Gn doses,the number of follicle(diameter≥14 mm),estradiol level,progesterone level on the hCG trigger day,the incidence of moderate-to-severe ovarian hyperstimulation syndrome(OHSS),fertilization method,number of 2PN fertilized oocytes,number of viable embryos,number of good quality embryos,mature oocyte rate,2PN cleavage rate and good quality embryos rate(all P>0.05).In the frozen-thawed embryo transfer cycle,the biochemical pregnancy rate,clinical pregnancy rate,embryo implantation rate,early abortion rate,ectopic pregnancy rate and on-going pregnancy rate per transfer were similar between the PPOS group and the GnRH-A group(all P>0.05).Conclusion The application of PPOS protocol in high ovarian responders can inhibit the premature LH surge while further reduce the risk of OHSS compared with GnRH-A protocol,without affecting the developmental potential of oocytes and the quality of embryos,and it can achieve comparable clinical pregnancy outcomes to the GnRH-A protocol.
作者
莫莉菁
付伟平
朱琴
王丽萍
方春霞
MO Lijing;FU Weiping;ZHU Qin;WANG Liping;FANG Chunxia(Reproductive Center,Jiaxing Municipal Maternal and Child Health Hospital,Jiaxing 314000,China)
出处
《浙江医学》
CAS
2021年第8期845-848,853,共5页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2020KY963)
嘉兴市科技计划项目(2019AY32004)。
关键词
卵巢高反应
高孕激素下促排卵
早发黄体生成素峰
冻融胚胎移植
High ovarian response
Progestin primed ovarian stimulation
Premature luteinizing hormone surge
Frozen-thawed embryo transfer
