生殖医学杂志

目的探讨不同控制性卵巢刺激(COS)方案对早发性卵巢功能不全(POI)患者获卵数和可用胚胎数的影响。方法回顾性分析2016年1月至2019年3月在我中心行IVF-ET治疗的184例POI患者,共行431个取卵周期。根据COS方案不同分为拮抗剂方案(n=121)、自然周期(n=55)、克罗米芬(CC)+促性腺激素(Gn)方案(n=149)、口服避孕药(OC)+Gn方案(n=60)、长方案(n=22)、超短方案(n=24)。采用广义估计方程(generalized estimating equation,GEE)分析的方法,探讨不同COS方案对POI患者获卵数和可用胚胎数的影响。结果对各组基线资料进行比较,不同COS方案周期患者间的夫妻双方年龄、BMI、基础FSH水平均无统计学差异(P>0.05);各组间基础窦卵泡数和AMH水平比较差异具有统计学意义(P<0.05)。拮抗剂方案、自然周期、CC+Gn方案、OC+Gn方案、长方案、超短方案的获卵数分别为(2.69±1.78)、(0.89±0.46)、(1.42±1.13)、(1.65±1.62)、(3.32±2.10)和(1.92±1.44)个,可用胚胎数分别为(1.24±1.15)、(0.44±0.54)、(0.55±0.74)、(0.72±0.90)、(1.55±1.63)和(0.96±1.08)个,可用胚胎率分别为(0.62±0.44)%、(0.45±0.50)%、(0.43±0.48)%、(0.43±0.46)%、(0.60±0.42)%和(0.54±0.49)%,组间差异均具有统计学意义(P<0.05)。进一步行多因素分析,自然周期、CC+Gn周期和OC+Gn周期的获卵数、MⅡ卵数及可用胚胎数显著少于拮抗剂方案(P<0.05)。结论对于POI患者,拮抗剂方案、长方案和超短方案可以获得相近的可用胚胎数,其中拮抗剂方案是第一选择方案,建议临床推广。对于自然周期、CC+Gn方案、OC+Gn方案在POI患者中的应用,仍然需要进一步探索。

Objective:To explore the outcomes of different control ovarian stimulation(COS) protocols in patients with premature ovarian insufficiency(POI).Methods:A retrospective analysis was performed on 184 POI patients treated by IVF-ET in our center from January 2016 to March 2019,with a total of 431 oocytes retrieval cycles. According to the different COS protocols,the patients were divided into antagonist protocol(n=121),natural cycle protocol(n=55),clomiphene(CC) + gonadotropin(Gn) protocol(n=149),oral contraceptive protocol(OC) + Gn protocol(n=60),long protocol(n=22),ultra-short protocol(n=24). The influence of different COS protocols on the number of oocytes retrieval and available embryos in POI patients was investigated by generalized estimation equation(GEE).Results:The baseline data of each group were compared. There was no significant difference in age,BMI and basal FSH level among the patients with different COS protocols(P>0.05). However,the number of basal antral follicles and AMH level were significantly different among the groups(P<0.05). The number of oocytes retrieval in antagonist protocol,natural cycle protocol,clomiphene plus Gn protocol,OC+Gn protocol,long protocol,ultra-short protocol was(2.69±1.78)、(0.89±0.46),(1.42±1.13),(1.65±1.62),(3.32±2.10) and(1.92±1.44) respectively;the number of available embryos was(1.24±1.15),(0.44±0.54),(0.55±0.74),(0.72±0.90),(1.55±1.63) and(0.96±1.08),respectively;and the available embryo rate was(0.62±0.44)%,(0.45±0.50)%,(0.43±0.48)%,(0.43±0.46)%,(0.60±0.42)%,(0.54±0.49)% respectively,with significant differences(P<0.05). Further multi-factor analysis showed that the number of oocytes retrieved,the number of MⅡ oocytes and the number of available embryos in the natural cycle protocol,CC+Gn protocol and OC+Gn protocol were significantly less than that of the antagonist protocol(P<0.05).Conclusions:For patients with POI,the antagonist protocol,long protocol and ultra-short protocol can obtain a similar number of available embryos,of which the antagonist protocol is the first choice,and clinical promotion is recommended. The application of natural cycle,CC+Gn regimen,and OC+Gn protocol in POI patients still needs further exploration.