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目的:探讨改良超长方案行体外受精-胚胎移植(IVF-ET)助孕的高龄(年龄≥40岁)且卵巢储备功能低下(窦卵泡3~7个)患者的治疗结局。方法:采用随机对照前瞻研究的方法,将行IVF-ET的120例高龄且卵巢储备功能低下患者随机分成:改良超长方案组(A组,n=55)和拮抗剂方案组(B组,n=65),比较A、B组间IVF-ET结局。结果:A组的Gn使用总量(3 955.2±1194.3 IU)、Gn使用天数(11.7±1.9 d)、hCG注射日E2水平(2 452.7±1 285.6 pg/ml),hCG注射日子宫内膜厚度(12.1±2.3 mm)均明显高于B组(分别为2 022.5±610.1 IU、9.1±1.7 d、1 257.7±696.0 pg/ml、11.3±2.0 mm),P<0.05;周期取消率、优质胚胎率、妊娠率、着床率、流产率、宫外孕发生率组间均无统计学差异(P>0.05)。A组hCG注射日LH水平(1.0±0.5 mIU/ml)及P/E2值(0.3±0.2)明显低于B组(3.4±2.4 mIU/ml及0.5±0.2),P<0.05。结论:改良超长方案经过GnRHa的预处理,使患者充分降调节,hCG注射日可以获得良好的LH水平、P/E2值及内膜厚度;而hMG的使用,既可降低患者费用,又可以适当补充LH,提高子宫内膜容受性。因此,对于高龄且卵巢储备功能低下的患者,改良超长方案是一个经济有效的治疗选择。
Objective: To investigate the therapeutic outcomes of elderly patients (aged 40 years or older) with poor ovarian reserve (3 to 7 folds of antral follicles) undergoing IVF-ET with modified long-term regimen. Methods: A total of 120 elderly patients with ovarian reserve dysfunction undergoing IVF-ET were randomly divided into three groups: the modified long arm (group A, n = 55) and the antagonist arm (arm B, n = 65), comparing the outcome of IVF-ET between A and B groups. Results: The total amount of Gn used in group A (3 955.2 ± 1194.3 IU), the number of days of Gn use (11.7 ± 1.9 d), E2 level on hCG injection day (2 452.7 ± 1 285.6 pg / ml), the endometrial thickness (12.1 ± 2.3 mm) were significantly higher than those in group B (2 022.5 ± 610.1 IU, 9.1 ± 1.7 d, 1 257.7 ± 696.0 pg / ml, 11.3 ± 2.0 mm respectively), P <0.05; Rate, pregnancy rate, implantation rate, abortion rate, ectopic pregnancy rates were no significant difference between groups (P> 0.05). The LH level (1.0 ± 0.5 mIU / ml) and P / E2 (0.3 ± 0.2) on the day of hCG injection in group A were significantly lower than those in group B (3.4 ± 2.4 mIU / ml and 0.5 ± 0.2), P <0.05. CONCLUSIONS: The modified long-term regimen is pre-treated with GnRHa to fully down-regulate the patient. Good LH level, P / E2 value and intima-media thickness can be obtained on the day of hCG injection. However, the use of hMG can reduce the cost of the patient, Appropriate to add LH, improve endometrial receptivity. Therefore, for patients with advanced and poor ovarian reserve, improving the long program is a cost-effective treatment option.