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目的探讨体外受精(IVF)周期中,卵泡发育迟缓者延长使用促性腺激素(Gn)的临床效果。方法将552个 IVF 周期按 Gn 用药时间、剂量和获卵数分组,观察组(69个取卵周期,66个移植周期):Gn 起始用量为75 IU/d～300 IU/d,用药时间≥16 d,用至卵泡达到取卵标准为止,获卵数≥4个;对照组(483个取卵周期,464个移植周期):Gn 起始用量为150 IU/d～300 IU/d,用药时间≤15 d,且总 Gn 用量≤3300 IU,获卵数≥4个。比较两组患者的 Gn 用量及用药时间、获卵数、临床妊娠率、胚胎着床率及治疗结局。结果观察组和对照组的临床妊娠率分别为45.5%(30/66)和51.7%(240/464);胚胎着床率分别为28.0%(46/164)和30.5%(385/1262);分娩率分别为37.9%(25/66)和39.4%(183/464);两组患者的临床妊娠率、胚胎着床率、分娩率等比较,差异均无统计学意义(P>0.05)。观察组和对照组的多囊卵巢(PCO)和(或)多囊卵巢综合征(PCOS)患者的比例分别为55.1%(38/69)和20.1%(97/483);基础窦卵泡数分别为(20±11)个和(15±6)个;Gn 用药时间分别为(20.8±4.2)d 和(10.3±1.8)d;Gn 用药总量分别为(3090±1140)IU 和(2302±862)IU;血清雌二醇峰值分别为(4595±5181)pmol/L 和(7272±6320)pmol/L;获卵数分别为(10±6)个和(14±7)个;移植胚胎数分别为(2.5±0.6)个和(2.7±0.5)个;两组上述各指标比较,差异均有统计学意义(P<0.01)。结论对 IVF 周期中卵泡发育迟缓的患者,延长使用 Gn 有效、方便,能获得满意的临床结局。
Objective To investigate the clinical effect of prolonged use of gonadotropin (Gn) in follicular delaying during in vitro fertilization (IVF) cycles. Methods 552 cycles of IVF were divided into groups according to Gn administration time, dose and number of oocytes retrieved. The observation group (69 cycles of oocyte retrieval and 66 cycles of transplantation): initial Gn dosage of 75 IU / d to 300 IU / d, The number of oocytes was ≥4. The control group (483 oocyte retrieval cycles, 464 cycles): the initial dosage of Gn was 150 IU / d ~ 300 IU / d, Medication time ≤ 15 d, and the total amount of Gn ≤ 3300 IU, oocyte number ≥ 4 months. Comparing the two groups of patients Gn dosage and medication time, number of oocytes retrieved, clinical pregnancy rate, embryo implantation rate and treatment outcome. Results The clinical pregnancy rates of observation group and control group were 45.5% (30/66) and 51.7% (240/464), respectively. The embryo implantation rates were 28.0% (46/164) and 30.5% (385/1262), respectively. The delivery rates were 37.9% (25/66) and 39.4% (183/464) respectively. There was no significant difference in clinical pregnancy rate, embryo implantation rate and delivery rate between the two groups (P> 0.05). The proportion of patients with PCO and PCOS in the observation group and the control group were 55.1% (38/69) and 20.1% (97/483), respectively. The number of basal antral follicles was Were (20 ± 11) and (15 ± 6) days respectively; the duration of Gn administration was (20.8 ± 4.2) days and (10.3 ± 1.8) days respectively; the total Gn dosage was (3090 ± 1140) IU and 862) IU; the peak values of serum estradiol were (4595 ± 5181) pmol / L and (7272 ± 6320) pmol / L respectively; the numbers of oocytes retrieved were (10 ± 6) (2.5 ± 0.6) and (2.7 ± 0.5), respectively. There was significant difference between the above two indexes (P <0.01). Conclusions In patients with IVF cycle follicular retardation, prolonged use of Gn is effective and convenient, and satisfactory clinical outcomes can be obtained.