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改良超长方案在卵巢低反应患者促排卵治疗中的应用 被引量:4

Application of modified supper long protocol in IVF/ICSI for poor ovarian responders
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摘要 目的探讨卵巢低反应(POR)患者在体外受精-胚胎移植(IVF-ET)/卵胞浆内单精子注射(ICSI)助孕治疗过程中行改良超长方案和灵活拮抗剂方案对其妊娠结局的影响。方法回顾性分析2013年1月1日至2013年12月31日在本院生殖中心接受IVF/ICSI助孕治疗的515例POR患者的临床资料,根据促排卵方案不同分为改良超长方案组(A组,n=137)和拮抗剂方案组(B组,n=378)。比较两组患者卵巢刺激天数(Gn天数)、Gn用量、HCG日激素水平、子宫内膜情况、平均获卵率、优胚率、受精率、着床率、临床妊娠率、移植周期取消率、流产率及宫外孕发生率等。结果与拮抗剂方案组比较,改良超长方案组的Gn天数[(12.42±2.80)vs.(8.53±2.54)d]、Gn用量[(4 447.81±2 804.28)vs.(1 916.67±622.62)U]、HCG日子宫内膜厚度[(12.15±2.66)vs.(10.53±2.31)mm]、平均获卵数[(2.97±1.50)vs.(2.43±1.52)个]均显著增加(P均<0.01),HCG日孕酮(P)水平[(0.46±0.27)vs.(0.56±0.26)nmol/L]、早发LH峰发生率(0vs.12.96%)、优胚率[(51.19±41.17)%vs.(63.72±38.74)%]、周期取消率(41.61%vs.53.17%)显著下降(P均<0.05)。改良超长方案组的着床率(33.99%vs.15.15%)、临床妊娠率(48.75%vs.26.55%)显著高于拮抗剂方案组(P均<0.01)。两组的流产率和宫外孕发生率比较无显著性差异(P>0.05)。结论POR患者行促排卵治疗时,选择改良超长方案可能更有利于改善IVF/ICSI-ET结局,但药物使用成本相对较高。 Objective: To compare IVF outcomes between modified supper long protocol and flexible antagonist protocol in women of poor ovarian response(POR).Methods: The clinical data of 515 POR patients undergone IVF/ICSI in our center from Jan.2013 to Dec.2013 were retrospectively analyzed.The patients were divided to two groups according to different protocol of ovulation induction:group A with modified supper long protocol(n=137)and group B with flexible antagonist protocol(n=378).The gonadotropin(Gn)duration and dosage,reproductive hormone levels and endometrial thickness on HCG day,number of oocytes retrieved,high-quality embryo rate,fertilization rate,implantation rate,clinical pregnancy rate,cycle cancellation rate,spontaneous abortion rate and ectopic pregnancy rate were compared between the two groups.Results: The Gn dosage[(4 447.81±2 804.28)vs.(1 916.67±622.62)U]and duration[(12.42±2.80)vs.(8.53±2.54)days)],endometrial thickness on HCG day [(12.15±2.66)vs.(10.53±2.31)mm],and number of oocytes retrieved[(2.97±1.50)vs.(2.43±1.52)]were significantly increased(all P〈0.01),while progesterone levels on HCG day [(0.46±0.27)vs.(0.56±0.26)nmol/L]and the premature LH surge rate(0% vs.12.96%),high-quality embryo rate [(51.19±41.17)% vs.(63.72±38.74)%],cycle cancellation rate(41.61% vs.53.17%)were significantly decreased(all P〈0.05)in group A compared with group B.The implantation rate(33.99% vs.15.15%)and pregnancy rate(48.75% vs.26.55%)in group A were significantly higher than those in group B(all P〈0.01).There were no significant differences in abortion rate and ectopic pregnancy rate between the two group(P〈0.05).Conclusions: The modified supper long protocol can improve the pregnant outcome compared with the flexible antagonist protocol in IVF/ICSI for the poor ovarian responders,but the cost of drug usage is relatively high.
作者 李元 龚斐
出处 《生殖医学杂志》 CAS 2016年第8期681-685,共5页 Journal of Reproductive Medicine
关键词 改良超长方案 拮抗剂方案 卵巢低反应 体外受精 胚胎移植 Modified supper long protocol Antagonist protocol Poor ovarian response IVF-ET
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参考文献15

  • 1Szymusik I,Marianowski P,Zygula A,et al.Poor responders in IVF--is there any evidence-based treatment for them?[J].Neuro Endocrinol Lett,2015,36:209-213.
  • 2Aksoy S,Yakin K,Seyhan A,et al.Does the use of gonadotropin-releasing hormone antagonists in natural IVF cycles for poor responder patients cause more harm than benefit?[J].Hum Fertil(Camb),2016:1-5.[Epub ahead of print].
  • 3Kolibianakis EM,Collins J,Tarlatzis BC,et al.Among patients treated for IVF with gonadotrophins and GnRH analogues,is the probability of live birth dependent on the type of analogue used?A systematic review and meta-analysis[J].Hum Reprod Update,2006,12:651-671.
  • 4Al-Inany HG,Youssef MA,Aboulghar M,et al.Gonadotrophin-releasing hormone antagonists for assisted reproductive technology[J].Cochrane Database Syst Rev,2011,(5):CD001750.
  • 5Giovanale V,Pulcinelli FM,Ralli E,et al.Poor responders in IVF:an update in therapy[J].Gynecol Endocrinol,2015,31:253-257.
  • 6Ubaldi F,Vaiarelli A,D’Anna R,et al.Management of poor responders in IVF:is there anything new?[J].Biomed Res Int,2014:352098.doi:10.1155/2014/352098.
  • 7李元,罗克莉,唐奕,张红,龚斐.改良超长方案改善卵巢低反应患者IVF/ICSI妊娠结局:一项自身对照研究[J].生殖医学杂志,2015,24(10):815-820. 被引量:9
  • 8D’Amato G,Caroppo E,Pasquadibisceglie A,et al.A novel protocol of ovulation induction with delayed gonadotropinreleasing hormone antagonist administration combined with high-dose recombinant follicle-stimulating hormone and clomiphene citrate for poor responders and women over 35years[J].Fertil Steril,2004,81:1572-1577.
  • 9Patrizio P,Vaiarelli A,Levi Setti PE,et al.How to define,diagnose and treat poor responders?Responses from a worldwide survey of IVF clinics[J/OL].Reprod Biomed Online,2015,30:581-592.
  • 10马海兰,龚斐,卢光琇.高龄卵巢低反应患者体外受精/卵胞浆内单精子注射治疗策略[J].生殖医学杂志,2013,22(1):71-76. 被引量:3

二级参考文献41

  • 1周灿权,钟依平.对超排卵反应不良患者的应对策略[J].实用妇产科杂志,2005,21(8):463-466. 被引量:14
  • 2黄洁,刘嘉茵.35岁以上不孕妇女卵巢反应及临床妊娠结局的预测[J].药物生物技术,2006,13(6):460-463. 被引量:6
  • 3Mohamed MA, Sbraeia M, Paechiarotti A, et al. Urinary follicle-stimulating hormone (FSH) is more effective than recombinant FSH in older women in a controlled randomized study[J]. Fertil Steril, 2006,85 : 1398-1403.
  • 4Swanton A,Child T. Reproduction and ovarian ageing[J]. J Br Menopause Soc, 2005,11 : 126-131.
  • 5Oudendijk JF, Yarde F, Eijkemans MJ, et al. The poor responder in IVF:is the prognosis always poor? A systematic review[J]: Hum Reprod Update, 2012,18 : 1-11.
  • 6Roudebush WE, Kivens WJ, Mattke JM. Biomarkers of ovarian reserve[J]. Biomark Insights, 2008,3 : 259-268.
  • 7Sharara FI,McClamroc HD. Use of microdose GnRH agonist protocol in women with low ovarian volumes undergoing IVF [J]. Hum Reprod, 2001,16 : 500-503.
  • 8Kupesie S, Kurjak A, Sjelos D, et al. Three-dimensional ultrasonographie ovarian measurements and in vitro fertilzation outcome are related to age [J]. Ferti[ Steril, 2003,79 : 190-197.
  • 9Bancsi LF, Brroekmans FJ, Eij kemans M J, et al. Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve[J]. Fertil Steril,2002.77:328-336.
  • 10Bassil S, Wyns C, Toussaint-Demylle D, et al. The relationship between ovarian vascularity and the duration of stimulation in in-vitro fertilization[J]. Hum Reprod, 1997, 12:1240-1245.

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