短效曲普瑞林长方案在卵巢储备降低患者中的应用

目的探寻卵巢储备降低患者最低有效剂量的曲普瑞林降调节方案。方法回顾性分析我院生殖中心接受体外受精-胚胎移植/卵胞浆内单精子注射(IVF-ET/ICSI)治疗的卵巢储备降低患者112个周期资料。根据降调方案分为:A组曲普瑞林短方案共61个周期,B组0.03 mg曲普瑞林长方案共51个周期。比较A、B两组患者的促性腺激素(Gn)用量、获卵数、受精率、优质胚胎率、种植率、临床妊娠率等。结果两组患者的平均年龄、不育年限、体重指数、基础内分泌值均无统计学差异(P0.05)。A组Gn用药量明显少于B组,获卵数多于B组,但其优质胚胎率明显低于B组(P0.05),两者的受精率和可移植胚胎数比较无显著性差异(P0.05),妊娠率、流产率差别亦无显著性(P0.05)。结论 0.03 mg曲普瑞林长方案可作为卵巢储备降低患者的超排卵备选方案之一。

Application of long protocol of triptorelin in ovarian stimulation for patients with poor ovarian reserve

Objective： To examine the efficacy of triptorelin long protocol in controlled ovarian stimulation （COS） for patients with poor ovarian reserve. Methods： Data of 112 IVF-ET/ICSI （In vitro fertilization and embryo transfer） cycles of women with poor ovarian reserve in our hospital were retrospectively analyzed. 112 cycles were divided into two groups according to the down-regulation protocols in COS： 61 cycles in group A （with 0.1 mg/d triptorelin short protocol） and 51 cycles in group B （with 0.03 mg/d triptorelin long protocol）. The total dose of gonadotropin （Gn）, hormone levels on hCG day, number of retrieved oocytes, fertilization rate, high quality embryo rate, implantation rate and clinical pregnancy rate were compared between two groups. Results： There was no difference in average age, infertility duration, body mass index and basal endo- crine hormone levels between two groups. Serum progesterone levels on hCG day were higher in group B than those in group A （P〈0. 01）, while luteinizing hormone or estradiol levels were comparable in two groups. The dose of Gn used in group A was significantly lower than that in group B （P〈0.01）, while the number of retrieved oocytes was higher in group A than in group B （P〈0.01）. However, the high quality embryo rate was lower in group A than in group B （P〈0.05）. There were no statistically differences between the two groups in fertilization rate, clinical pregnancy rate or miscarriage rate, though the clinical pregnancy rate was numerically higher in group B. Conclusions： Long protocol of down regulation with 0.03mg /d short-acting triptorelin could be a choice for patients with poor ovarian reserve in controlled ovarian hyperstimulation.