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目的:比较高龄不孕女性体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)中微量短效Gn RH-a长方案及常规短方案的促排卵效果及临床结局。方法:回顾性分析602例≥35岁不孕患者682个周期IVF/ICSI-ET临床结局,按促排卵方案分为微量短效Gn RH-a长方案组(172个周期,A组)和常规短方案组(510个周期,B组),再以年龄段分层(35~37岁,38~39岁及≥40岁),分别比较不同年龄段两种促排卵方案的效果及临床结局。结果:A组Gn用量、Gn使用天数显著高于B组(P<0.05),MII卵数、优质胚胎率、胚胎移植数、周期取消率均无统计学差异(P>0.05);A组与B组相比,临床妊娠率、活产率(36.1%vs 29.8%;28.5%vs 23.3%;P>0.05)有改善趋势;尤其在35~37岁及38~39岁患者中,A组优质胚胎率、临床妊娠率、活产率(52.89%vs 47.16%,50.14%vs47.97%;41.7%vs 36.7%,36.4%vs 22.2%;35.0%vs 29.2%,24.2%vs 15.7%;P均>0.05)均有明显改善趋势。结论:≥35岁不孕女性微量Gn RH-a长方案临床结局有改善趋势,可作为高龄不孕女性,尤其是35~39岁不孕患者的有效促排卵方案之一。
Objective: To compare the ovulation-promoting effect and clinical outcome of the short-term Gn-RH-a long-term regimen and conventional short-term regimen in in vitro fertilization / intracytoplasmic sperm injection / embryo transfer (IVF / ICSI-ET) in elderly infertile women. Methods: The clinical outcomes of 682 cycles of IVF / ICSI-ET in 602 patients with infertility ≥35 years were retrospectively analyzed. According to the ovulation induction protocol, they were divided into two groups: long-term and short-term GnRH-a regimens Short-term group (510 cycles, group B), and then stratified by age group (35-37 years old, 38-39 years old and ≥40 years old), respectively, the effect of different ovulation induction programs and clinical outcomes. Results: The amount of Gn in group A was significantly higher than that in group B (P <0.05), the number of MII eggs, the rate of high quality embryo, the number of embryo transfer and the cycle cancellation rate were not significantly different (P> 0.05) The clinical pregnancy rate, live birth rate (36.1% vs 29.8%; 28.5% vs 23.3%; P> 0.05) showed a trend of improvement compared with group B, especially among 35-37 years and 38-39 years old group A, Embryo rate, clinical pregnancy rate and live birth rate (52.89% vs 47.16%, 50.14% vs 47.97%; 41.7% vs 36.7%, 36.4% vs 22.2%; 35.0% vs 29.2% vs 24.2% vs 15.7%; P > 0.05) have significantly improved the trend. Conclusion: The clinical outcome of the long-term Gn-RH-a regimen in 35-year-old infertile women tends to be improved. It can be used as an effective ovulation induction regimen for elderly infertile women, especially 35-39-year-old infertile women.