生殖医学杂志

目的探讨不同方案在高龄卵巢低反应(POR)不孕女性IVF/ICSI-ET周期中的应用效果。方法回顾性分析2015年1月至2018年3月期间于我中心行IVF/ICSI-ET助孕的高龄、卵巢低反应患者的临床资料,按照纳入标准共收集符合条件的351个周期,并根据控制性促排卵(COH)方案的不同分为两组:降调组73个周期,非降调组278个周期。比较两组患者的一般资料、获卵数、受精率、可用胚胎数、鲜胚移植率、鲜胚移植周期临床妊娠率及冻融胚胎移植(FET)临床妊娠率等。结果降调组与非降调组患者的平均年龄、不孕年限、体重指数(BMI)、基础FSH及基础窦卵泡数(AFC)比较均无显著性差异(P>0.05)。鲜胚移植周期中,降调组的Gn天数、Gn总量、HCG日内膜厚度、HCG日E2水平、获卵数、MⅡ卵数、受精率、胚胎数、可用胚胎数、鲜胚移植周期率显著高于非降调组(P<0.05);临床妊娠率、种植率、流产率、宫外孕率两组间比较均无显著性差异(P>0.05)。FET周期中,两组的转化日内膜厚度、平均移植胚胎数、临床妊娠率、种植率、流产率、宫外孕率比较均无显著性差异(P>0.05)。降调组获得妊娠的最短时间显著短于非降调组(P<0.05);其他指标如鲜胚移植总费用、FET总费用、新鲜周期一例临床妊娠费用、解冻周期一例临床妊娠费用等组间比较均无显著性差异(P>0.05)。结论对于35～40岁高龄的POR患者,小剂量的降调节方案可能较其他方案有更大的优势。但由于本研究样本量较少,需要后续更大样本量的对照研究加以探讨验证。

Objective:To investigate the effect of different options in women with advanced age and poor ovarian response(POR)in IVF/ICSI-ET cycles.Methods:The clinical data of elderly female patients with POR who underwent IVF/ICSI-ET in our center from January 2015 to March 2018 were retrospectively analyzed.A total of 351 cycles with eligible conditions were collected according to the inclusion criteria and divided into two groups according to the control ovulation induction(COH)protocol:GnRH agonist(GnRH-a)down-regulation group(n=73)and non-down-regulation group(n=278).The general data,the number of oocytes retrieved,the fertilization rate,the number of available embryos,the rate of fresh embryo transfer,the clinical pregnancy rate of fresh embryo transfer cycle and frozen-thawed embryo transfer(FET)were compared between the two groups.Results:There was no significant difference in mean age,infertility duration,BMI,basal FSH and AFC between the down-regulated and non-down-regulated patients(P>0.05).In the fresh cycle,the days&total amount of Gn used,endometrial thickness & E2 level on HCG day,number of oocytes retrieved,number of M Ⅱ oocytes,fertilization rate,number of embryos & available embryos and fresh transplantation cycle rate in down-regulated group were significantly higher than those in non-downregulation group(P<0.05),but the clinical pregnancy rate,implantation rate,abortion rate and ectopic pregnancy rate were not significantly different(P>0.05).In the FET cycles,there were no significant differences in the endometrial thickness on conversion day,average number of transplanted embryos,clinical pregnancy rate,implantation rate,abortion rate,and ectopic pregnancy rate between the two groups(P>0.05).The shortest days of pregnancy in down-regulation group was significantly shorter than that in the non-down-regulation group(P<0.05).Other indicators such as the total cost of fresh and FET cycle,the clinical pregnancy cost of one fresh or FET cycle were not significantly different between the two groups(P>0.05).Conclusions:For patients aged 35 to 40 years old,the low-dose down-regulation protocol may have a greater advantage than other protocol.However,due to the small sample size of this study,it is necessary to conduct a follow-up study with a larger sample size to verify it.