生殖医学杂志

目的探讨3种不同促排卵方案应用于高龄卵巢储备功能减退(DOR)患者助孕治疗的临床结局。方法回顾性分析2017年1月至2019年5月于第九○○医院生殖中心行辅助生殖技术助孕治疗的高龄DOR患者共计371个周期的临床资料,按照促排卵方案不同分为3组:A组(高孕酮状态下促排卵方案组,n=60),B组(拮抗剂方案组,n=166)和C组(微刺激方案组,n=145)。比较各组患者的一般资料、促排卵及胚胎发育情况、临床结局及费效比。结果 3组间Gn总量、Gn天数、获卵数比较有显著性差异(P<0.05),B组最多,C组最少。3组的成熟卵率、2原核(2PN)受精率、2PN卵裂率、D3优胚率、囊胚形成率、优质囊胚率、周期取消率比较均无显著性差异(P>0.05)。B组的每一启动周期总费用及每启动周期到首次移植费用显著高于A、C组(P<0.05);A、B、C三组每获1枚成熟卵及每获1枚优胚所需费用比较无显著性差异(P>0.05)。B组有新鲜周期移植,鲜胚移植临床妊娠率为49.43%,达到妊娠的时间(TTP)显著低于A、C组,累积妊娠率则显著高于A、C组(P<0.05)。结论对于高龄DOR患者,拮抗剂方案可以行新鲜周期移植,明显缩短了TTP,具有较高的累积妊娠率及可接受的费效比,值得临床推广。

Objective:To explore the advantages and limitations of three controlled ovarian hyper-stimulation protocols in advanced-age patients with diminished ovarian reserve(DOR).Methods:The data of 371 cycles of advanced-age patients with DOR who underwent IVF treatment in the reproductive center of 900^th hospital from January 2017 to May 2019 were retrospectively analyzed.The cycles divided into 3 groups according to the controlled ovarian hyper-stimulation protocols:group A(progestin-primed ovarian stimulation,n=60),group B(antagonist protocol,n=166),and group C(micro-stimulation protocol,n=145).The general data,the status of induced ovulation and embryo development,clinical efficacy and cost-effectiveness ratio were compared among the groups.Results:The total amount & days of Gn and numbers of oocytes retrieved in group B were the most,and which in group C were the least.There were significant differences among the three groups(P<0.05). There were no significant differences in the mature oocyte rate,2 PN fertilization rate,2 PN cleavage rate,high-quality embryo rate on Day 3,blastocyst formation rate,and high-quality blastocyst rate among the three groups(P>0.05).The total cost of each initiating cycle and the total cost from initiating cycle to complete the first transplant in group B were significantly higher than those in groups A and C(P<0.05). There was no significant difference in the cost per mature oocyte and per good-quality embryo obtained among the group A,B and C(P>0.05).The clinical pregnancy rate of fresh cycle in group B was 49.43%,the time to pregnancy(TTP) was significantly lower than that in group A and C,and the cumulative pregnancy rate was significantly higher than that in group A and C(P<0.05).Conclusions:In advanced-age patients with DOR,the GnRH antagonist protocol allows fresh cycle transplantation,which significantly shortens TTP.This protocol has higher cumulative pregnancy rate and an acceptable cost-effectiveness ratio,which is worthy of popularization in the clinic.