摘要
目的比较卵巢储备功能减退、高龄(≥40岁)患者在体外受精-胚胎移植周期中采用降调节方案和拮抗剂方案的应用效果。方法回顾性分析2017年1月至2021年5月于聊城市人民医院生殖医学科行体外受精/卵胞质内单精子注射-胚胎移植助孕的≥40岁合并卵巢储备功能减退患者的临床资料,按照纳入标准共收集符合条件的142例患者均151个周期,并根据控制性促排卵方案的不同分为两组:降调组29例患者31个周期,拮抗剂组113例患者120个周期。比较两组患者的一般情况、临床治疗情况、实验室数据、临床助孕结局。统计学方法采用独立样本t检验、Wilcoxon符号秩和检验、Fisher确切概率法、χ^(2)检验。结果两组患者的年龄、不孕年限、体质量指数、基础卵泡刺激素、基础雌二醇、抗缪勒管激素及窦卵泡计数比较差异均无统计学意义(t=1.204、-1.634、0.741、-0.643、1.491、1.868、1.270,均P>0.05)。降调组使用促性腺激素天数[(10.16±2.85)d比(8.60±2.79)d]、囊胚形成率[77.78%(14/18)比39.47%(15/38)]、优质囊胚形成率[50.00%(9/18)比13.16%(5/38)]均高于拮抗剂组,差异均有统计学意义(t=2.722、χ^(2)=7.177、8.842,均P<0.05);两组受精率、双原核率、优质胚胎率比较差异均无统计学意义(χ^(2)=0.018、0.662、2.375,均P>0.05);降调组新鲜移植临床妊娠率[22.73%(5/22)比11.11%(3/27)]、活产率[13.64%(3/22)比3.70%(1/27)]均高于拮抗剂组,降调组流产率低于拮抗剂组[40.00%(2/5)比75.00%(2/3)],但差异均无统计学意义(均P>0.05)。结论对于≥40岁合并卵巢储备功能减退的高龄不孕女性,采用降调节方案有增加临床妊娠率、降低流产率的趋势。
Objective To compare the effects of using down regulation protocol and gonadotropin-releasing hormone(GnRH)antagonist protocol in women with diminished ovarian reserve aged more than 40 years during in vitro fertilization-embryo transfer(IVF-ET).Methods The clinical data of patients with diminished ovarian reserve aged more than 40 years undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer in Department of Reproductive Medicine,Liaocheng People's Hospital from January 2017 to May 2021 were retrospectively analyzed.A total of 142 women with 151 cycles were collected according to the inclusion criteria,and were divided into two groups according to the controlled ovulation induction protocols:a down regulation group(29 women with 31 cycles)and a GnRH antagonist group(113 women with 120 cycles).The general data,clinical treatment,laboratory data,outcomes of clinical assisted pregnancy outcomes were compared between the two groups.Independent sample t test,Wilcoxon rank sum test,Fisher exact probability method,andχ^(2) test were used for statistical analysis.Results There were no statistically significant differences in the age,infertility years,body mass index,basal follicle stimulating hormone(FSH),basal estradiol(E2),anti-Mullerian hormone,and antral follicle count between the two groups(t=1.204,-1.634,0.741,-0.643,1.491,1.868,and 1.270;all P>0.05).The number of Gn days[(10.16±2.85)d vs.[8.60±2.79)d],blastocyst formation rate[77.78%(14/18)vs.39.47%(15/38)],and high quality blastocyst formation rate[50.00%(9/18)vs.13.16%(5/38)]of the down-regulation group were higher than those of the GnRH antagonist group,with statistically significant differences(t=2.722,χ^(2)=7.177 and 8.842;all P<0.05).There were no statistically significant differences in the fertilization rate,2PN rate,and high-quality embryo rate between the two groups(χ^(2)=0.018,0.662,and 2.375;all P>0.05).The clinical pregnancy rate[22.73%(5/22)vs.11.11%(3/27)]and live birth rate[13.64%(3/22)vs.3.70%(1/27)]of the down-regulation group were higher than those of the GnRH antagonist group,and the abortion rate of the down-regulation group was lower than that of the GnRH antagonist group[40.00%(2/5)vs.75.00%(2/3)],but there were no statistically significant differences(all P>0.05).Conclusion For patients with diminished ovarian reserve aged more than 40 years,the down regulation protocol has a trend to increase the clinical pregnancy rate and reduce the abortion rate.
作者
李辉
郭艳霞
孙昕卉
郭虹敏
侯东升
Li Hui;Guo Yanxia;Sun Xinhui;Guo Hongmin;Hou Dongsheng(Department of Reproductive Medicine,Liaocheng People's Hospital,Liaocheng 252000,China)
出处
《国际医药卫生导报》
2023年第9期1223-1227,共5页
International Medicine and Health Guidance News
基金
山东省中医药科技发展计划项目(2019-0888)。
关键词
卵巢储备功能减退
降调节方案
拮抗剂方案
≥40岁
Diminished ovarian reserve
Down-regulation protocol
GnRH antagonist protocol
Aged more than 40 years
