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目的:筛选影响卵巢反应性的相关因素,用以指导临床制定合理的超排卵方案。方法:回顾性分析183例进行长方案降调下行控制性超排卵治疗者,按获卵数>15枚和4～15枚且使用Gn起步≤3支/d分为高反应组(n=96)和正常反应组(n=87)。结果:与低反应组比,高反应组窦卵泡数较多(P<0.05)、注射hCG日E2水平高(P<0.01)、基础FSH水平较低(P<0.05)。Logistic分析示基础FSH水平为保护因素(B=-0.608,P<0.01),窦卵泡数(B=1.675,P<0.01)、降调后LH水平(B=0.98,P=0.01)为危险因素。使用Gn 2支/d(75 IU/支)和3支/d起步发生高反应的几率分别是1支/d起步的7.4倍和6.7倍,而两者本身无显著差异。治疗结局:高反应组冷冻胚胎率和卵巢过度刺激综合症(OHSS)发生率均高于正常反应组(P<0.05)。结论:对于窦卵泡数多、基础FSH水平低或降调后LH水平较高的患者应尽量采用Gn 1支/d起步。
Objective: To screen the relevant factors that affect the ovarian response, to guide the clinical development of a reasonable superovulation program. Methods: A retrospective analysis of 183 patients with long-term regimen descending down-controlled ovarian hyperstimulation was divided into three groups according to the number of oocytes> 15 and 4 ~ 15 and the initial Gn ≤ 3 / d ) And normal reaction group (n = 87). Results: Compared with the low response group, the number of antral follicles in the high reaction group was higher (P <0.05), the E2 level on the day of hCG injection was higher (P <0.01) and the level of basic FSH was lower (P <0.05). Logistic analysis showed that basal FSH levels were protective factors (B = -0.608, P <0.01), antral follicle count (B = 1.675, P <0.01) and LH levels (B = 0.98, P = 0.01) . The odds of having a high reaction with Gn 2 / d (75 IU / support) and 3 / d starting were 7.4 and 6.7 times the start of 1 support / d, respectively, and there was no significant difference between the two. Treatment outcome: The incidence of frozen embryos and ovarian hyperstimulation syndrome (OHSS) in high response group were higher than those in normal response group (P <0.05). CONCLUSIONS: Patients with a high number of antral follicles, low basal FSH levels, or high LH levels should be encouraged to start with Gn 1 / d.