摘要
目的探讨高孕激素状态下促排卵(PPOS)方案在反复常规超促排卵方案失败的体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)患者中的应用。方法回顾性分析2017年1月至2018年12月期间于厦门大学附属第一医院生殖中心行长方案、拮抗剂方案促排卵失败,第3次促排卵继续采用常规超促排卵方案或换用PPOS方案行IVF/ICSI的76例正常卵巢储备功能患者资料。根据促排卵方案不同分为两组:常规超促排卵方案组(A组)(n=46)、PPOS方案组(B组)(n=30)。比较患者使用两种促排卵方案后促排卵临床情况、实验室情况及临床妊娠结局等指标。结果A、B两组患者的一般情况具有可比性,B组患者正常受精率(78.3%)、可用胚胎率(69.5%)及累积妊娠率(60.0%)均高于A组(70.3%,P=0.031;57.9%,P=0.017;34.8%,P=0.031),差异均有统计学意义。B组患者优质胚胎率(52.4%)略高于A组(48.0%),差异无统计学意义(P=0.061)。而两组患者的促性腺激素(Gn)使用时间、Gn使用总量、人绒毛膜促性腺激素(hCG)注射日雌二醇水平、成熟卵数(率)、卵裂率、种植率、妊娠率、流产率等组间比较差异均无统计学意义(P>0.05)。结论对于采用常规超促排卵方案反复失败再次行IVF/ICSI-ET的卵巢储备功能正常的患者,PPOS方案可以提高患者正常受精率、可用胚胎率及累积妊娠率,可能提高优质胚胎率,改善患者临床妊娠结局。PPOS方案为常规超促排卵方案反复失败的卵巢储备功能正常患者再次选择促排卵方案提供一种新思路。
Objective To explore the application of progestin-primed ovarian stimulation protocol in patients with repeated in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)failure undregoing conventional controlled ovarian hyperstimulation(COH).Methods The clinical data of 76 patients from January 2017 to December 2018 in Reproductive Center of the First Affiliated Hospital of Xiamen University with normal ovarian reserve who failed to get pregnancy with long protocol and gonadotropin-releasing hormone(GnRH)antagonist protocol,adopting long protocol or GnRH antagonist protocol again or administered with progestin-primed ovarian stimulation(PPOS)protocol followed by frozen-thawed embryo transfer(FET),were analyzed retrospectively.They were divided into two groups:conventional COH protocol group(group A,n=46),PPOS group(group B,n=30)according to different protocols.The clinical indicators,laboratory indicators and clinical pregnancy outcomes were compared between the two groups.Results The general conditions of patients in groups A and B were comparable.The normal fertilization rate(78.3%),available embryo rate(69.5%)and cumulative pregnancy rate(60.0%)in group B were higher than those in group A(70.3%,P=0.031;57.9%,P=0.017;34.8%,P=0.031).The difference was statistically significant.The high-quality embryo rate(52.4%)in group B was slightly higher than that in group A(48.0%)with no statistical significance(P=0.061).There were no significant differences between the two groups in the total amount of gonadotropin(Gn),the duration,estradiol level on human chorionic gonadotropin(hCG)injection day,amount and rate of MII oocytes,the number of two pronucleus(2PN)embryos,the cleavage rate,the implantation rate,the clinical pregnancy rate,and the early abortion rate(P>0.05).Conclusion For the patients with normal ovarian reserve function who failed to get pregnancy repeatedly with conventional COH protocols,PPOS protocol can improve the normal fertilization rate,the available embryo rate and the cumulative pregnancy rate,and may increase the high-quality embryo rate and eventually improve clinical pregnancy outcome.PPOS protocol provides a new way for these patients to choose COH protocol thirdly.
作者
高红
林莉
颜晓红
李友筑
Gao Hong;Lin Li;Yan Xiaohong;Li Youzhu(Reproductive Medicine Center of the First Affiliated Hospital of Xiamen University,Xiamen 361003,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2020年第2期94-100,共7页
Chinese Journal of Reproduction and Contraception
基金
福建省自然科学基金(2019J01565)。
关键词
高孕激素状态下促排卵
控制性超促排卵
卵巢储备功能
受精
体外
卵胞质内单精子注射
反复失败
Progestin-primed ovarian stimulation
Controlled ovarian hyperstimulation
Ovary reserve
Fertilization in vitro
Intracytoplasmic sperm injection
Repeated failure
作者简介
通信作者:李友筑,Email:232398106@qq.com,电话/传真:+86-592-2662318。
