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目的:探讨卵巢低反应(poor ovarian response,POR)患者在体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)技术中应用微刺激方案更合适的取卵时机。方法:回顾性分析接受微刺激方案IVF/ICSI-ET助孕的POR患者共363个周期的临床资料,分为来曲唑(LE)+尿促性腺素(hMG)+后半程氯米芬片(CC)组(A组)和全程CC+hMG组(B组)。观察分析临床及实验室指标、不同取卵时机获卵情况及后续冻融胚胎移植(FET)周期的妊娠结局。结果:患者的Gn使用天数、扳机日E2、取卵前日E2、MⅡ卵率组间比较差异均有统计学意义(P<0.05)。取卵前日E2与扳机日E2相比上升者注射达菲林后33 h取卵获卵情况要差于35 h和36 h取卵者(P<0.05),而取卵前日E2与扳机日E2相比下降者,下降比例≤1/3者获卵率要明显优于>1/3者(P<0.05)。结论:POR患者应用微刺激方案时,取卵前日E2与扳机日E2相比,上升者,可注射达菲林后35~36 h取卵;下降者,下降比例≤1/3,可33 h取卵,如下降比例>1/3,则提示33 h后取卵获卵情况差。
Objective: To investigate the timing of ovulation in microinvasion program of in vitro fertilization / intracytoplasmic sperm injection / embryo transfer (IVF / ICSI-ET) in patients with poor ovarian response (POR). Methods: The clinical data of 363 cycles of POR patients receiving IVF / ICSI-ET assisted therapy were retrospectively analyzed and divided into three groups: letrozole (LE) + urinary gonadotropin (hMG) + clomiphene (CC) group (group A) and full CC + hMG group (group B). Observation and analysis of clinical and laboratory indicators, the timing of different oocyte retrieval and follow-up of frozen-thawed embryo transfer (FET) cycles of pregnancy outcomes. Results: There were significant differences in the number of days of Gn use, trigger day E2, E2 before ovulation, and the incidence of ovulation in M II (P <0.05). The E2 level on the day before ovulation was higher than that on the trigger day E2 (P <0.05), but the level of E2 on the day before ovulation and the E2 phase on the trigger day The declining rate, the declining rate of ≤ 1/3, the ovulation rate was significantly better than> 1/3 (P <0.05). CONCLUSIONS: When using the micro-stimulation regimen in POR patients, the E2 level on the day before ovulation is higher than that on the trigger day E2, and can be taken 35 to 36 hours after the injection of dafenilin. The decrease rate is less than 1/3, Eggs, such as the decline in the proportion of> 1/3, suggesting that after 33 h oocyte retrieval worse.