联合促性腺激素/枸橼酸氯米芬的非降调节卵巢刺激方案在卵巢反应不良患者中的应用

目的探讨联合促性腺激素/枸橼酸氯米芬的非降调节卵巢刺激方案(改良卵巢刺激方案)在符合Bologna诊断标准的卵巢反应不良(POR)患者行IVF/ICSI-ET治疗中的应用价值。方法采用回顾性队列研究,收集2012年1月至2014年12月间在本院生殖中心行标准长方案IVF/ICSI-ET助孕的卵巢反应不良患者(SLP组,191例),同时依据患者年龄和基础窦卵泡数以1∶2比例匹配行改良卵巢刺激方案助孕的患者(MOS组,382例)。比较两组患者的各助孕指标和妊娠结局。结果 MOS组的平均获卵数及平均正常受精卵数均显著多于SLP组(P均0.05)。虽MOS组与SLP组比较在每移植周期的累积临床妊娠率上无显著差异(55.34%vs.53.57%,P0.05),但MOS组的周期取消率、早孕期流产率显著低于SLP组(分别为15.18%vs.23.56%和8.77%vs.20.00%)(P均0.05),因此MOS组每启动周期的累积活产率显著高于SLP组(38.74%vs.28.79%,P=0.02)。Logistic多因素回归分析显示获卵数及可利用胚胎数增加时POR患者的累积活产率亦显著增加(P0.001)。结论改良卵巢刺激方案在卵巢反应不良患者可获得优于标准长方案的临床助孕结局,其应是卵巢反应不良患者可选择的促排卵方案。

Comparison of the efficacy of a modified non-down regulation ovarian stimulation protocol and standard long protocol in poor responder

Objective: To explore the efficacy of a modified and non-down regulation ovarian stimulation protocol(continuously co-treated with clomiphene citrate and gonadotropin) in the treatment of poor ovarian responder(POR) in accordance with Bologna criteria.Methods: A retrospective cohort study was conducted to collect the patients who underwent IVF/ICSI-ET treatment in our center from January 2012 to December 2014.Among the patients,191 patients with POR fulfilled the Bologna criteria and underwent IVF/ICSI-ET with standard long protocol(SLP group).The patients in SLP group were well-matched with POR patients undergone modified ovarian stimulation protocol(MOS group,n=382) at ratio 1:2 according to their age and basal antral follicle count.The pregnancy indicators and outcomes were compared between the two groups.Results: The number of retrieved oocytes and normal fertilized zygotes in MOS group were significantly more than those in the SLP group(P＜0.05).Although there was no significant difference in the cumulative clinical pregnancy rate per embryo transfer cycle between the two groups(55.34% vs.53.57%,P＞0.05),the cycle cancellation rate(15.18% vs.23.56%) and the abortion rate(8.77% vs.20.00%) in MOS group were significantly lower than those in the SLP group(P＜0.05).Thus a significantly higher cumulative live birth rate per initiated cycle was observed in MOS group than that in SLP group(38.74% vs.28.79%,P=0.02).Logistic regression analysis showed that the cumulative live birth rate was also significantly increased when the numbers of oocytes retrieved and transplantable embryos increased in the POR patients(P＜0.001).Conclusions: The modified ovarian simulation protocol can achieve better clinical outcomes compared with the standard long protocol.It can be used as a new promising approach for POR patients.