摘要
目的探讨既往微刺激/温和刺激促排卵方案助孕失败的卵巢储备功能减退(DOR)患者改用拮抗剂方案联合生长激素(GH)预处理的临床效果。方法回顾性分析2018年1月至2021年6月在无锡市妇幼保健院生殖中心既往微刺激/温和刺激促排卵方案助孕失败后改用拮抗剂方案联合GH预处理的62例DOR患者的临床资料,并按年龄分为<35岁组和≥35岁组;比较前后两种促排卵方案的促排卵情况、胚胎质量、不同年龄患者临床资料以及改用拮抗剂联合GH预处理方案后的妊娠结局。结果相对于前次微刺激/温和刺激方案,拮抗剂方案联合GH预处理的Gn总量、Gn天数、扳机日E 2水平、获卵数、可移植胚胎数、优质胚胎数及优胚率均显著提高(P<0.05);前后两次方案间正常受精率及卵裂率无统计学差异(P>0.05)。拮抗剂方案联合GH预处理后鲜胚移植23个周期,临床妊娠率为60.87%(14/23),流产率为14.29%(2/14);冻融胚胎移植32个周期,临床妊娠率为37.50%(12/32),流产率为16.67%(2/12)。按年龄分组(<35岁组和≥35岁组)后,两组间一般资料比较无统计学差异(P>0.05);与>35岁组相比,<35岁组的患者鲜胚移植周期种植率、临床妊娠率及冻融胚胎移植周期种植率均显著提高(P<0.05),两组间流产率及冻融移植周期临床妊娠率均无统计学差异(P>0.05)。结论拮抗剂方案联合GH预处理可以明显改善前次促排卵失败的DOR患者的临床妊娠结局,尤其在<35岁的患者中更具优势;拮抗剂方案联合GH预处理的DOR患者建议选择新鲜周期移植。
Objective:To investigate the clinical effect of GnRH antagonist(GnRH-ant)protocol combined with growth hormone(GH)pretreatment in patients with diminished ovarian reserve(DOR)who failed to conceive with previous minimal/mild ovulation induction protocol.Methods:The clinical data of 62 DOR patients who were treated with GnRH-ant protocol combined with GH pretreatment after the failure of minimal/mild stimulation protocol in the Reproductive Medicine Center of Wuxi Maternity&Child Health Care Hospital from January 2018 to June 2021 were retrospectively analyzed.The patients were divided into two groups by age:<35 years old group and≥35 years old group.Ovarian stimulation status,embryonic quality,clinical data of patients of different ages and pregnancy outcomes after switching to antagonist combined with GH pretreatment were compared between the two group.Results:Gonadotropin(Gn)total doses,Gn days,serum estradiol level on the trigger day,number of oocyte retrieved,number of transplantable embryos,number and rate of high-quality embryos in GnRH-ant protocol combined with GH pretreatment group were significantly higher than those in minimal/mild stimulation group(P<0.05).No significant differences were found in normal fertilization rate,cleavage rate between the two protocols(P>0.05).In GnRH-ant combined with GH pretreatment,the clinical pregnancy rate was 60.87%(14/23)and the abortion rate was 14.29%(2/14)in 23 fresh embryo transfer cycles.The clinical pregnancy rate was 37.50%(12/32)and the abortion rate was 16.67%(2/12)in 32 frozen-thawed embryo transfer(FET)cycles.There were no significant differences in basic data between<35 years group and≥35 years group(P>0.05).The embryo implantation rate,clinical pregnancy rate in the fresh cycles and embryo implantation rate in FET cycles in<35 years group were significantly higher than those in≥35 years group(P<0.05).There were no significant differences in the abortion rate and clinical pregnancy rate in FET cycles between the two age groups(P>0.05).Conclusions:The
作者
曾惠明
陈洁
熊芳
徐丽爽
ZENG Hui-ming;CHEN Jie;XIONG Fang;XU Li-shuang(Wuxi Maternal&Health Hospital Affiliated to Nanjing Medical University,Wuxi 214002)
出处
《生殖医学杂志》
CAS
2022年第10期1355-1360,共6页
Journal of Reproductive Medicine
基金
无锡市科教强卫青年医学人才项目(QNRC078)。
