微刺激方案在常规IVF-ET治疗失败后卵巢低反应患者中的应用

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目的:探讨微刺激方案在IVF-ET过程中对卵巢低反应患者的应用价值。方法:对56例卵巢低反应患者应用常规促排卵方案进行112个IVF周期治疗失败后改用微刺激方案的201个周期进行回顾性分析,比较使用这2种方案的治疗效果及临床结局,同时比较微刺激方案中使用与未使用GnRH-拮抗剂的临床数据与治疗结局。结果:112个常规促排卵周期中6个周期取消。106个周期取卵,95个周期获得卵母细胞,平均获卵数3.7±1.5个。共91个周期进行胚胎移植,均未获得妊娠。201个微刺激周期中17个周期取消,184个取卵周期中163个周期获得卵母细胞,平均获卵数3.4±1.4个。共160个周期进行胚胎移植,临床妊娠18例,双胎妊娠2例,流产3例,胚胎种植率为5.9%(20/336),起始周期临床妊娠率为9.8%(18/184),移植周期临床妊娠率为11.3%(18/160),累计继续妊娠率为26.8%(15/56)。比较前、后2种方案,常规促排卵方案中刺激时间为12.0±1.4 d,Gn使用总量为3 780±1 350 IU,远多于微刺激方案中的8.0±1.2 d和650±120 IU(P<0.05),而hCG注射日E2值(860±36 pg/ml vs 756±28 pg/ml)、平均获卵数(3.7±1.5 vs 3.4±1.4)、受精率(68.5%vs 64.5%)、优质胚胎率(56.7%vs 47.7%)2种方案均无显著性差异(P>0.05)。微刺激周期中使用拮抗剂组较未使用拮抗剂组周期取消率降低(4.5%vs 22.0%),hCG注射日LH值降低(2.3±1.1 U vs 7.8±2.4 U)(P<0.05),优质胚胎率(53.7%vs 25.7%)、胚胎着床率(6.5%vs3.9%)及临床妊娠率(12.3%vs 6.7%)均有增高的趋势,但差异均无统计学意义(P>0.05)。结论:微刺激方案对卵巢反应不良患者具有简便、疗程短、患者心理负担轻、医疗风险小等特点,值得推广应用,并建议联合拮抗剂使用。 Objective: To investigate the application value of micro-stimulation regimen in patients with low ovarian response during IVF-ET. Methods: A retrospective analysis was conducted on 201 cycles of micro-stimulating regimen after 112 cycles of IVF failure in 56 cases of ovarian low response patients who were treated with conventional ovulation induction. The therapeutic effects and clinical outcomes of these two regimens were compared. Clinical data and treatment outcomes with and without GnRH-antagonists in the micro-stimulation regimen were compared. Results: 6 cycles of 112 routine ovulation induction cycles were canceled. 106 cycles of oocyte retrieval, 95 cycles of oocyte, the average number of oocytes retrieved 3.7 ± 1.5. A total of 91 cycles of embryo transfer, have not been pregnant. 17 cycles of 201 micro-stimulation cycles were canceled and oocytes were obtained in 163 cycles of 184 oocyte retrieval cycles, with an average of 3.4 ± 1.4 oocytes retrieved. A total of 160 cycles of embryo transfer, 18 cases of clinical pregnancy, twin pregnancy in 2 cases, abortion in 3 cases, embryo implantation rate was 5.9% (20/336), the initial cycle clinical pregnancy rate was 9.8% (18/184) The clinical pregnancy rate was 11.3% (18/160) in the transplant cycle, and the cumulative pregnancy rate was 26.8% (15/56). Compared with the former 2 and the latter 2 regimens, the stimulating time in routine ovulation induction was 12.0 ± 1.4 d, and the total Gn use was 3 780 ± 1 350 IU, which was much more than the 8.0 ± 1.2 d and 650 ± 120 IU in the micro stimulus (P <0.05), and the E2 value on the day of hCG injection was (860 ± 36 pg / ml vs 756 ± 28 pg / ml). The average number of oocytes retrieved was 3.7 ± 1.5 vs 3.4 ± 1.4. The fertilization rate was 68.5% ), High-quality embryos (56.7% vs 47.7%) had no significant difference between the two methods (P> 0.05). The cancellation rate was lower (4.5% vs 22.0%) in the micro-stimulation period than that of the un-used antagonist group, and the LH value was decreased by 2.3 ± 1.1 U vs 7.8 ± 2.4 U on the day of hCG injection (P <0.05) Embryo rate (53.7% vs 25.7%), embryo implantation rate (6.5% vs 3.9%) and clinical pregnancy rate (12.3% vs 6.7%) all showed an increasing trend, but the differences were not statistically significant ). Conclusion: The micro-stimulating regimen is simple, short course, light psychological burden and low medical risk for patients with ovarian failure. It is worth popularizing and applying, and it is suggested that the combination of antagonists should be used.
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