生殖医学杂志

目的探讨卵巢储备功能减退(DOR)患者行体外受精-胚胎移植(IVF-ET)新鲜移植周期临床妊娠结局的可能影响因素。方法回顾性分析251例新鲜移植周期DOR患者的临床资料,根据促排卵方案、年龄分为4组:年龄小于35岁使用长方案105例、短方案53例;年龄35岁以上使用长方案者37例、短方案56例。比较各组患者的基础FSH值、窦卵泡数、卵巢反应情况、子宫内膜厚度、促排卵情况及妊娠结局,并比较移植D3卵裂期胚胎组及D5囊胚期胚胎组的临床妊娠结局。结果 (1)年龄<35岁患者:长方案组较短方案组,移植日内膜厚度[(12.20±2.39)vs.(11.27±2.42)mm]、获卵数[(6.50±2.75)vs.(4.80±2.48)]、受精数[(5.02±2.43)vs.(3.74±2.19)]、卵裂数[(4.92±2.41)vs.(3.64±2.16)]、优胚数[(1.97±1.86)vs.(1.23±1.38)]及冷冻胚胎数[(1.18±1.54)vs.(0.60±1.08)]均显著增高(P<0.05);(2)年龄≥35岁:长方案组受精数显著高于短方案组[(4.92±2.27)vs.(3.86±2.06)](P<0.05);(3)相同促排方案不同年龄组比较:长方案组随着年龄的增加,Gn总量[(3 184.30±1 262.12)vs.(3 878.03±1 466.53)U]显著增加(P<0.05),而获卵数、受精数、卵裂数、冷冻胚胎数均减少,但无统计学差异(P>0.05);短方案组两个年龄组比较各临床指标均无统计学差异(P>0.05);(4)各年龄组长方案较短方案,以及各方案组年轻者较年长者,胚胎种植率及临床妊娠率较高、流产率较低,但均无统计学差异(P>0.05);(5)移植D3卵裂期胚胎或D5囊胚期胚胎的妊娠结局未见统计学差异(P>0.05)。结论 DOR患者在促排卵治疗时,选择长方案可能更有利于改善助孕结局;DOR患者随着年龄的增加临床结局趋于下降;在获卵少的情况下建议选择卵裂期优质胚胎移植。

Objective: To investigate the possible factors affecting the clinical outcome of fresh transplantation cycle in IVF in the patients with ovarian reserve dysfunction(DOR).Methods: The data of 251 controlled ovarian stimulation cycles were retrospectively analyzed.According to ovulation protocol and age,the patients were divided into four groups:105 patients with long protocol &53 patients with short protocol in the patients less than 35 years;37 patients with long protocol and 56 patients with short protocol in the patients over 35 years.The basic FSH levels,number of antral follicle,response of ovarian stimulation,endometrial thickness,outcome of ovulation induction and pregnancy were compared among the groups.The clinical pregnancy outcomes were also compared between D3 cleavage stage embryo group and D5 blastocyst stage embryo group.Results:In the patients less than 35 years,endometrial thickness[(12.20±2.39)vs.(11.27±2.42)mm],the numbers of oocytes retrieval[(6.50±2.75)vs.(4.8±2.48)],fertilization [(5.02±2.43)vs.(3.74±2.19)],cleavage[(4.92±2.41)vs.(3.64±2.16)],high-quality embryos[(1.97±1.86)vs.(1.23±1.38)],and frozen embryos [(1.18±1.54)vs.(0.60±1.08)]in long protocol were significantly higher than those in short protocol(P<0.05).In the patients over 35 years,the number of fertilization in long protocol was significantly higher than short protocol [(4.92±2.27)vs.(3.86±2.06)](P <0.05).Between the two age group,there were no statistical differences in the implantation rate,clinical pregnancy rate,abortion rate(P>0.05).Comparison of different age groups in same protocol,the total amount of gonadotropin(Gn)used was significantly higher[(3 184.30±1 262.12)vs.(3 878.03±1 466.53)U](P<0.05),and the numbers of oocytes retrieval,fertilization,cleavage,frozen embryos were reduced,but no significant difference(P>0.05)along with the increase of age in long protocol.There were no significant differences in the clinical parameters in short protocol(P>0.05).There were no significant differences in embryo implantation rate,clinical pregnancy rate and abortion rate between the short protocol and long protocol for each age group and between the younger group and the elder group in each protocol group(P>0.05).There was no significant difference in the clinical outcome between transplanted D3 cleavage stage embryo and D5 blastocyst stage embryo(P>0.05).Conclusions: The long-term protocol might be more beneficial in improving ovulation outcomes for DOR patients.The clinical outcomes tended to decrease with increasing age in DOR patients.It is recommended to choose high-quality embryo transfer at the time of cleavage when the number of oocytes retrieval is low.