[1]刘 洋,南 燕,陈 帆,等.不同促排卵方案在高龄卵巢储备功能减退患者中的应用效果比较[J].新乡医学院学报,2020,37(5):465-470.[doi:10.7683/xxyxyxb.2020.05.016]
 LIU Yang,NAN Yan,CHEN Fan,et al.Application effect of different ovarian stimulation protocols in elderly patients with diminished ovarian reserve[J].Journal of Xinxiang Medical University,2020,37(5):465-470.[doi:10.7683/xxyxyxb.2020.05.016]
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不同促排卵方案在高龄卵巢储备功能减退患者中的应用效果比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年5
页码:
465-470
栏目:
临床研究
出版日期:
2020-05-05

文章信息/Info

Title:
Application effect of different ovarian stimulation protocols in elderly patients with diminished ovarian reserve
作者:
刘 洋南 燕陈 帆王 慧李玉洁
(新乡医学院第三附属医院生殖医学科,河南 新乡 453003)
Author(s):
LIU YangNAN YanCHEN FanWANG HuiLI Yujie
(Department of Reproductive Medicine,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China)
关键词:
卵巢储备功能减退高龄促性腺激素释放激素拮抗剂促排卵微刺激
Keywords:
diminished ovarian reserveadvanced agegonadotrophin-releasing hormone antagonisovarian stimulationminimal stimulation
分类号:
R715.9
DOI:
10.7683/xxyxyxb.2020.05.016
文献标志码:
A
摘要:
目的 比较不同促排卵方案在高龄卵巢储备功能减退(DOR)患者中的应用效果,为高龄DOR患者促排卵方案的选择提供参考。方法 选择2016年12月至2019年7月于新乡医学院第三附属医院行体外受精-胚胎移植(IVF-ET)助孕的153例高龄DOR患者为研究对象,根据促排卵方案分为促性腺激素释放激素抑制剂(GnRHant)方案组(n=45)、微刺激方案组(n=56)、卵泡期高孕激素状态下促排卵(PPOS)方案组(n=52),分别给予相应的促排卵方案。采用阴道超声引导下穿刺取卵术进行取卵,进行IVF-ET,采用彩色超声诊断仪检测患者月经周期2~4 d双侧卵巢窦卵泡计数(AFC)、促排卵期间卵泡生长情况、冻融胚胎移植(FET)日子宫内膜厚度;采用全自动微粒子化学发光免疫系统检测患者月经周期2~4 d空腹静脉血血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、抗苗勒管素(AMH)及人绒毛膜促性腺激素(HCG)注射日LH、E2、孕酮(P)水平;统计患者促性腺激素(Gn)应用时间、Gn使用总量、早发LH峰率、获卵数、第2次减数分裂(MⅡ)卵母细胞数、双原核(2PN)数、可利用胚胎数、未获胚率、周期取消率、优胚率、胚胎种植率、生化妊娠率、早期流产率、临床妊娠率。结果 3组患者Gn应用时间、HCG注射日E2和P水平及获卵母细胞数、MⅡ卵数、2PN数、可利用胚胎数、优胚率、未获胚率、周期取消率比较差异无统计学意义(F/χ2=0.846、1.146、2.297、2.973、2.952、2.466、2.545、0.192、1.080、1.772,P>0.05)。3组患者Gn使用总量、HCG注射日LH水平及早发LH峰率比较差异有统计学意义(F/χ2=7.050、14.389、7.131,P<0.05);其中GnRHant方案组患者Gn使用总量高于微刺激方案组、PPOS方案组(P<0.05);微刺激方案组患者早发LH峰率、HCG注射日LH水平高于GnRHant方案组、PPOS方案组(P<0.05)。GnRHant方案组、微刺激方案组、PPOS方案组患者有效FET周期率分别为60.00%(27/45)、53.57%(30/56)、53.84%(28/52),3组患者有效FET周期率比较差异无统计学意义(χ2=0.511,P>0.05)。GnRHant方案组、微刺激方案组、PPOS方案组患者的胚胎种植率分别为20.37%、20.00%、21.43%,3组患者胚胎种植率比较差异无统计学意义(χ2=0.038,P>0.05)。GnRHant方案组、微刺激方案组、PPOS方案组患者移植日子宫内膜厚度分别为(9.33±1.72)、(9.10±1.31)、(9.25±1.33)mm,3组患者移植日子宫内膜厚度比较差异无统计学意义(F=0.189,P>0.05)。GnRHant方案组、微刺激方案组、PPOS方案组患者生化妊娠率分别为33.33%、36.67%、35.71%,3组患者生化妊娠率比较差异无统计学意义(χ2=0.011,P>0.05)。GnRHant方案组、微刺激方案组、PPOS方案组患者早期流产率分别为11.11%、13.33%、10.71%,3组患者早期流产率比较差异无统计学意义(χ2=0.224,P>0.05)。GnRHant方案组、微刺激方案组、PPOS方案组患者临床妊娠率分别为25.93%、23.33%、25.00%,3组患者临床妊娠率比较差异无统计学意义(χ2=0.053,P>0.05)。结论 高龄DOR患者使用GnRHant方案、微刺激方案、PPOS方案的临床结局无明显差异;但PPOS方案的早发LH峰率低,有效抑制LH峰作用强,是高龄DOR患者值得推荐的促排卵方案。
Abstract:
Objective To compare the application effect of different ovarian stimulation protocols in elderly patients with diminished ovarian reserve(DOR) and provide reference for the selection of ovarian stimulation protocol in elderly patients with DOR.Methods A total of 153 elderly patients with DOR who were treated with in vitro fertilization and embryo transfer(IVF-ET) in the Third Affiliated Hospital of Xinxiang Medical University from December 2016 to July 2019 were selected as the study subjects.According to different ovarian stimulation protocols,they were divided into gonadotrophin-releasing hormone antagonis (GnRHant) protocol group(n=45),minimal stimulation protocol group(n=56) and progestin-primed ovarian stimulation (PPOS) protocol group(n=52).The patients in the three groups were given corresponding ovarian stimulation protocols.The oocytes were extracted by puncture under the guidance of vaginal ultrasound, and then IVF-ET were performed.The bilateral ovarian antral follicle count(AFC),follicle growth during ovarian stimulation and endometrial thickness on the day of freeze-thaw embryo transfer (FET) were measured with color ultrasound diagnostic instrument at 2-4 days of the menstrual cycle.The serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2 ) and anti-mullerian hormone(AMH)at 2-4 days of the menstrual cycle,and the levels of LH,E2  and progesterone(P) on the day of injection of human chorionic gonadotrophin(HCG) were detected by automatic microparticle chemiluminescence immune system.The gonadotrophin(Gn) injection days,total dose of Gn using,early onset LH peak rate,the number of obtaining oocytes,the number of oocytes in the second meiotic division (MⅡ),double pronucleus(2PN) number,the number of available embryos,the failed embryo rate,cycle cancellation rate,the rate of superior embryo,embryo implantation rate,biochemical pregnancy rate,early abortion rate and clinical pregnancy rate were recorded.Results There was no statistically significant difference in the Gn injection days,E2  and P levels on the HCG injection day, the number of obtaining oocytes,the number of oocytes in MⅡ ,2PN number,the number of available embryos,the rate of superior embryo,failed embryo rate,cycle cancellation rate among the three group(F/χ2 =0.846,1.146,2.297,2.973,2.952,2.466,2.545,0.192,1.080,1.772;P>0.05).There were significant differences in the total dose of Gn using,the level of LH on the HCG injection day and early onset LH peak rate among the three groups(F/χ2 =7.050,14.389,7.131;P<0.05).The total dose of Gn using in the GnRHant protocol group was higher than that in the minimal stimulation protocol group and PPOS protocol group(P<0.05).The early onset LH peak rate and the level of LH on the HCG injection day in the minimal stimulation protocol group were higher than those in the GnRHant protocol group and PPOS protocol group.The effective FET cycle rate in the GnRHant protocol group,minimal stimulation protocol group and PPOS protocol group was 60.00% (27/45),53.57% (30/56) and 53.84% (28/52),respectively.There was no significant difference in the effective FET cycle rates among the three groups(χ2 =0.511,P>0.05).The embryo implantation rate among the GnRHant protocol group,minimal stimulation protocol group and PPOS protocol group was 20.37%,20.00% and 21.43%,respectively.There was no statistically significant difference in the embryo implantation rates of patients among the three groups(χ2 =0.038,P>0.05).The endometrial thickness on implantaion day in the GnRHant protocol group,minimal stimulation protocol group and PPOS protocol group was (9.33±1.72),(9.10±1.31) and (9.25±1.33) mm,respectively.There was no statistically significant difference in the endometrial thickness implantaion day of patients among the three groups(F=0.189,P>0.05).The biochemical pregnancy rate in GnRHant protocol group,minimal stimulation protocol group and PPOS protocol group was 33.33%,36.67% and 35.71%,respectively;there was no significant difference in the biochemical pregnancy rates of patients among the three groups(χ2 =0.011,P>0.05).The early abortion rate in the GnRHant protocol group,minimal stimulation protocol group and PPOS protocol group was 11.11%,13.33% and 10.71%,respectively;there was no statistically significant difference in the early abortion rate of patients among the three groups(χ2 =0.224,P>0.05).The clinical pregnancy rate in the GnRHant protocol group,minimal stimulation protocol group and PPOS protocol group was 25.93%,23.33% and 25.00%,respectively;there was no statistically significant difference in the clinical pregnancy rates of patients among the three groups(χ2 =0.053,P>0.05).Conclusion There is no statistically significant difference in the clinical outcome of elder patients with DOR by using GnRHant protocol,minimal stimulation protocol and PPOS protocol.However, PPOS protocol has a low early onset LH peak rate,a strong peak inhibition effect on LH.It is a recommended ovarian stimulation protocol for elderly DOR patients.

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更新日期/Last Update: 2020-05-05