不同预处理方案对卵巢储备功能下降患者IVF-ET结局的影响

目的 比较不同预处理方案对卵巢储备功能下降(DOR)患者体外受精-胚胎移植(IVF-ET)结局的影响.方法 采用前瞻性队列研究,分析DOR患者248个IVF-ET助孕周期的临床资料,按照预处理方案不同分为DHEA组、坤泰胶囊组和对照组,比较3组患者的基础内分泌、窦卵泡数(AFC)、抗苗勒管激素(AMH)、促性腺激素(Gn)总量和天数、获卵数、受精率、优质胚胎率、胚胎种植率及临床妊娠率.结果 预处理前,3组基础内分泌、AMH、AFC等差异均无统计学意义(P＞ 0.05).与对照组相比,DHEA组AFC显著增加(P＜0.05),坤泰胶囊组AFC也有增加,但差异无统计学意义(P＞0.05);且2组基础FSH略降低,获卵数也略高于对照组,但差异均无统计学意义(P＞0.05).3组Gn总量与天数、受精率、优质胚胎率、胚胎种植率及临床妊娠率等差异均无统计学意义(P＞0.05).结论 DHEA可通过增加AFC改善DOR患者的卵巢功能,并可在一定从程度上增加获卵数,但对卵巢反应性和临床结局的影响尚需进行大样本研究.

The effects of different pretreatment regimens on IVF-ET outcome in diminished ovarian reserve patients

Objective To compare the effects of different pretreatment regimens on in vitro fertilization-embryo transfer (IVF-ET) outcomes in patients with diminished ovarian reserve (DOR).Methods A prospective cohort study was performed.The clinical data of 248 DOR patients who underwent IVF-ET treatment were analyzed.According to the pretreatment regimens,patients were divided into three groups,including the DHEA group,the Kuntai capsules group and the control group.The following index were compared among three groups,including serum basal hormone levels,anti-Mullerian hormone (AMH),antral follicle counts (AFC),the total doses and duration of gonadotropin (Gn),the number of retrieved oocytes,fertilization rate,high quality embryo rate,implantation rate of embryo and clinical pregnancy rate.Results Before pretreatment,there was no significant difference among the three groups in the basal hormone levels,AMH and AFC (P ＞ 0.05).Compared with the control group,the AFC of the DHEA group was significantly increased (P ＜0.05),and the AFC of Kuntai capsule group was also increased,but the difference was not statistically significant (P ＞0.05).In the groups of DHEA and Kuntai capsule,the basal follicle stimulating hormone (bFSH) was slightly decreased,and the number of retrieved oocytes was slightly increased,but the difference was not statistically significant (P ＞ 0.05).There was no significant difference among the three groups in the following index,including the total doses and duration of Gn,fertilization rate,high quality embryo rate,implantation rate of embryo and clinical pregnancy rate (P ＞ 0.05).Conclusion DHEA can improve the ovarian reserve of DOR patients by increasing AFC,and it can increase the number of retrieved oocytes to a certain extent.And a larger sample size may be needed for further study about the effects of DHEA on the ovarian response and the clinical outcome.