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目的探讨使用地屈孕酮预处理对卵巢储备功能下降(DOR)患者体外受精-胚胎移植(IVF-ET)治疗相关参数及妊娠结局的影响。方法 96例符合DOR诊断标准的不孕患者,采用拮抗剂方案进行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)辅助助孕。将患者随机分为A组(34例)、B组(32例)和C组(30例)。预处理A组于体外受精(IVF)助孕前一月经周期黄体期口服地屈孕酮10mg/次,t.i.d.,连续使用13 d;预处理B组于IVF助孕前一月经周期黄体期口服地屈孕酮10mg/次,b.i.d.,连续使用10 d;C组作为对照组未行预处理。分析比较三组患者治疗周期相关参数及妊娠结局的变化。结果预处理A组、预处理B组在人绒毛膜促性腺激素(HCG)日的雌二醇(E_2)水平显著高于C组,差异有统计学意义(P<0.05);预处理A组、预处理B组在于月经第3天的卵泡刺激素(FSH)水平显著低于C组,差异有统计学意义(P<0.05)。但预处理A、B组比较差异无统计学意义(P>0.05)。A、B、C三组患者依次两两比较,月经第3天的E_2、促黄体生成素(LH)水平和HCG日的LH、孕酮(P)水平以及窦卵泡计数(AFC)、促性腺激素(Gn)天数和Gn量、拮抗剂天数和量以及HCG日子宫内膜(Em)厚度比较差异均无统计学意义(P>0.05)。预处理A组的获卵数(6.92±3.05)个、受精率(73.06±25.42)%、优胚率(73.8%)和着床率(38.9%)显著高于C组(4.25±2.02)个、(60.51±18.32)%,(60.4%)、(26.0%),差异有统计学意义(P<0.05);且A组Gn启动第4天、第7天和HCG日卵泡生长的不均匀率(最大卵泡直径与次大卵泡直径平均直径相差≥3 mm)显著低于C组,差异有统计学意义(P<0.05)。预处理A组与预处理B组比较,差异无统计学意义(P>0.05)。预处理B组与C组各临床结局指标比较差异无统计学意义(P>0.05)。A、B、C三组患者依次两两比较,Gn启动日卵泡不均匀率、临床妊娠率以及孕早期流产率比较差异均无统计学意义(P>0.05)。结论拮抗剂方案超促排卵的前一月经周期黄体期口服地屈孕酮预处理可以有效改善卵巢储备功能下降患者的Gn启动第4天、第7天和HCG日的卵泡不均匀率,增强超促排卵效果,增加获卵数,提高受精率和优质胚胎率,进而可以有效提高IVF/ICSI-ET的胚胎种植率和临床妊娠率,推荐剂量为黄体期口服地屈孕酮10 mg,t.i.d.×13 d。
Objective To investigate the effect of dydrogesterone pretreatment on the parameters related to in vitro fertilization-embryo transfer (IVF-ET) and pregnancy outcomes in patients with decreased ovarian reserve (DOR). Methods Ninety - six infertile women with DOR diagnostic criteria were enrolled in this study. In vitro fertilization / IVS / ET combined with IVF / ICSI assisted the pregnancy. The patients were randomly divided into A group (34 cases), B group (32 cases) and C group (30 cases). Group A was pretreated with in vitro fertilization (IVF) by oral administration of progesterone orally 10 mg once per day during the menstrual cycle, tid for 13 consecutive days, and group B pretreated orally by IVF during the first menstrual cycle Ketone 10mg / time, bid, continuous use of 10 d; C group as a control group without pretreatment. Analysis and comparison of the three groups of patients with treatment-related parameters and pregnancy outcome changes. Results The level of E2 in pretreatment group A and pretreatment group B was significantly higher than that in C group on the day of human chorionic gonadotropin (HCG), the difference was statistically significant (P <0.05). Pretreatment group A , While the pretreatment group B had significantly lower follicle stimulating hormone (FSH) level on the third day of menstruation than that of the C group, the difference was statistically significant (P <0.05). However, there was no significant difference in pretreatment between A and B groups (P> 0.05). Group A, B, and C were compared with each other in turn, E_2, LH, LH and progesterone (P) levels on the 3rd day of menstruation and AFC, There was no significant difference in the number of days of Gn and Gn, the number and days of antagonist, and the thickness of endometrium on day HCG (P> 0.05). The number of oocytes retrieved in pretreatment group A (6.92 ± 3.05), fertilization rate (73.06 ± 25.42)%, excellent embryo rate (73.8%) and implantation rate (38.9%) were significantly higher than those in group C (4.25 ± 2.02) , (60.51 ± 18.32)%, (60.4%) and (26.0%) respectively, and the difference was statistically significant (P <0.05). Moreover, the non-uniformity of follicle growth on day 4, 7 and HCG in group A (The difference between the diameter of the largest follicle and the average diameter of the follicle size≥3 mm) was significantly lower than that of the C group (P <0.05). There was no significant difference between pretreatment group A and pretreatment group B (P> 0.05). There was no significant difference in clinical outcome between pretreatment group B and group C (P> 0.05). A, B, C three groups of patients followed by each pairwise comparison, Gn start day follicle inhomogeneity, clinical pregnancy rate and early pregnancy miscarriage rate differences were not statistically significant (P> 0.05). Conclusions Overexpression of antagonist regimen orally pre-menstrual cycle luteal phase during the first menstrual cycle can effectively improve the ovarian reserve decline in patients with Gn on the fourth day, the seventh day and HCG day follicular non-uniformity, enhanced ultra Promote ovulation, increase the number of oocytes, improve fertilization rate and high quality embryo rate, which can effectively improve the embryo implantation rate and clinical pregnancy rate of IVF / ICSI-ET. The recommended dosage is orally administered progesterone 10 mg, tid × 13 d.