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目的:探讨在低剂量重组人促卵泡刺激素(rFSH)递增方案诱导排卵中临床结局的预测因子。方法:总结全国22家生殖中心对WHO II型无排卵为主要不孕原因的患者使用低剂量rFSH递增方案共433个诱导排卵周期中418个符合疗效分析的周期的临床妊娠率、单卵泡发生率、周期取消率、卵巢过度刺激综合征(OHSS)发生率;比较37.5 IU和75.0 IU不同rFSH启动剂量的临床、实验室结局,分析单卵泡发育、卵巢诱导成功、周期取消与年龄、体质量指数(BMI)、卵巢储备等预测因子间的关系。结果:①所有对象临床妊娠率为17.94%,单卵泡发育率为57.66%,OHSS发生率为2.31%,多胎妊娠率为0.23%,周期取消率为12.68%;②果纳芬(rFSH)平均治疗天数为12.7±5.6 d,平均总使用剂量为813.8±480.4 IU,平均阈剂量为73.0±29.7 IU;其中75.12%的患者总使用剂量<1 000 IU,73.68%的人群刺激天数在5~15 d之间;③启动剂量为37.5 IU者较启动剂量为75 IU者的卵巢诱导时间明显增加(14.1±5.6 d vs 10.9±4.9 d,P=0.000),果纳芬总使用剂量明显减少(767.0±495.0 IU vs879.1±542.7 IU,P=0.000),单卵泡发育率明显增加(62.30%vs 51.15%,P=0.027),周期取消率明显升高(17.62%vs 5.75%,P=0.000);OHSS发生率无明显差异(2.87%vs 1.72%,P=0.532),临床妊娠率和生化妊娠率亦无统计学差异(P>0.05);④不同阈剂量下临床妊娠率和生化妊娠率均无统计学差异(P>0.05);体质量≥70 kg时阈剂量明显增加;⑤周期取消的预测因素与年龄呈负相关(r=-0.169,OR=0.845,95%CI=0.744~0.960,P=0.010),与既往诱导排卵周期数呈正相关(r=-0.240,OR=1.271,95%CI=1.093~1.478,P=0.002)。结论:低剂量递增方案诱导排卵可以取得较高的单卵泡发育率和临床妊娠率,且降低并发症发生率。不同启动剂量与刺激天数和总使用剂量相关,但对临床结局无明显影响;周期取消可能与年龄和既往诱导排卵周期有关。
OBJECTIVE: To investigate the predictors of clinical outcome in ovulation induced by low dose recombinant human follicle stimulating hormone (rFSH) regimen. Methods: The clinical pregnancy rate, the incidence of single follicles in 418 cycles of curative effect analysis of 433 ovulation induction cycles were summarized in 22 reproductive centers of the WHO type 2 infertility who did not use ovulation induction as the main infertility patients. , Cycle cancellation rate and ovarian hyperstimulation syndrome (OHSS) incidence. The clinical and laboratory outcomes of 37.5 IU and 75.0 IU different rFSH priming dosages were compared. Single follicle development, ovarian induction success, cycle cancellation and age, body mass index (BMI), ovarian reserve predictors such as the relationship between. Results: ① The clinical pregnancy rate was 17.94%, the single follicle development rate was 57.66%, the incidence of OHSS was 2.31%, the multiple pregnancy rate was 0.23% and the cycle cancellation rate was 12.68%. ② The average treatment rate of rFSH The average daily dose was 813.8 ± 480.4 IU and the mean threshold dose was 73.0 ± 29.7 IU, of which 75.12% had a total dose of less than 1 000 IU and 73.68% of the population had a stimulus day of 5-15 days (14.1 ± 5.6 d vs 10.9 ± 4.9 d, P = 0.000). The total dose of propafenone significantly decreased (767.0 ± 495.0 IU vs 879.1 ± 542.7 IU, P = 0.000). The rate of single follicle development was significantly increased (62.30% vs 51.15%, P = 0.027), and the cycle cancellation rate was significantly higher (17.62% vs 5.75%, P = 0.000). There was no significant difference in the incidence of OHSS (2.87% vs 1.72%, P = 0.532). There was no significant difference in clinical pregnancy rate and biochemical pregnancy rate (P> 0.05). ④ The clinical pregnancy rate and biochemical pregnancy rate (P> 0.05). The threshold dose was significantly increased when the body mass was greater than or equal to 70 kg. (5) The predictive factors of cycle cancellation were negatively correlated with age (r = -0.169, OR = 0.845,95% CI = 0.744-0.960, P = 0.010), which was positively correlated with the number of previously induced ovulation cycles (r = -0.240, OR = 1.271, 95% CI = 1.093-1.478, P = 0.002). CONCLUSION: Ovulation induced by low dose escalation regimen can achieve a higher rate of single follicle development and clinical pregnancy, and reduce the incidence of complications. Different starting doses were related to days of stimulation and total dose, but had no significant effect on clinical outcome. Periodic abrogation may be related to age and previous induction of ovulation cycles.