两种微刺激方案在卵巢低反应患者的自身对照分析

摘要

目的 探讨两种微刺激方案克罗米芬(CC) +来曲唑(LE) +促性腺激素(Gn)和安宫黄体酮(MPA)+Gn先后在42例卵巢低反应患者的临床应用.方法 回顾性分析在郑州大学第三附属医院生殖中心行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕的42例卵巢低反应患者,该42例患者先使用CC+LE+Gn方案(A方案),形成可利用胚胎移植后未孕,改用MPA + Gn方案(B方案).比较两种方案的Gn总量、促排天数、注射促性腺激素释放激素激动剂(GnRH-a)日血清雌二醇(E2) 、黄体生成素(LH) 、孕酮(P)水平、平均获卵数、卵泡早排率、受精率、可利用胚胎数、优胚率等各项指标.结果 两种方案相比较,促排天数无统计学差异(t=3.42,P>0.05),但B方案的Gn总量明显高于A方案,且差异有统计学意义(t=20.21,P<0.05).注射GnRH-a日血清E2 、LH 、P水平无统计学差异(t值分别为1.75、1.28、1.41,均P>0.05),B方案获卵数明显多于A方案,差异有统计学意义(t=5.20,P<0.05),但两种方案卵泡早排率、受精率、可利用胚胎数、优质胚胎率均无统计学差异(t/χ2值分别为2.01、5.32、2.86、3.87,均P>0.05).结论 卵巢低反应患者IVF/ICSI促排卵周期应用CC+LE+Gn微刺激方案和MPA+Gn微刺激方案临床效果相近,并且前者Gn使用总量较后者低,因此可减轻患者单周期治疗费用.%Objective To explore the application of mini-stimulation protocol of clomiphene (CC) +letrozole (LE) gonadotropin (Gn) and of medroxyprogesterone acetate (MPA)+Gn successively in 42 patients with poor ovarian response.Methods Forty-two patients with poor ovarian response treated with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) in reproductive center of Third Affiliated Hospital of Zhengzhou University were analyzed retrospectively.CC+LE+Gn protocol (protocol A) was firstly applied in 42 patients who were not pregnant after implantation of available embryos.Then they were treated with MPA+Gn protocol (protocol B).Total dose of Gn, ovulation induction time, levels of serum estradiol (E2), luteinizing hormone (LH), and progesterone (P) on day of gonadotrophin releasing hormone agonist (GnRH-a) injection, average number of retrieved oocytes, premature follicular discharge rate, fertilization rate, available embryos, and rate of good quality embryo were compared between two protocols.Results There was no significant difference in ovulation induction time between two protocols (t=3.42,P>0.05), but the dose of Gn in protocol B was significantly higher than that in protocol A and difference had statistical significance (t=20.21,P<0.05).Levels of E2, LH and P on the day of GnRH-a injection were not significantly different (t value was 1.75, 1.28 and 1.41, respectively, all P>0.05).Average number of retrieved oocytes in protocol B was significantly larger that in protocol A and the difference was statistically significant (t=5.20, P<0.05).But there was no significant difference in premature follicular discharge rate, fertilization rate, available embryos, rate of good quality embryo between two protocols (t/χ2 value was 2.01, 5.32, 2.86 and 3.87, respectively, all P>0.05).Conclusion Clinical efficacy of mini-stimulation protocols CC+LE+Gn and MPA+Gn applied in IVF/ICSI-ET ovulation cycle in patients with poor ovarian response is similar, but the administration dose of Gn in the former is less than that in the latter and thus it can reduce monocyclic treatment.cost.