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体外受精治疗中促性腺激素的剂量和卵巢反应性与临床结局的关系
引用本文:熊夏思,陈士岭,孙玲,尹敏娜,赵二勇,宋娟.体外受精治疗中促性腺激素的剂量和卵巢反应性与临床结局的关系[J].南方医科大学学报,2008,28(5):712-714.
作者姓名:熊夏思  陈士岭  孙玲  尹敏娜  赵二勇  宋娟
作者单位:南方医科大学南方医院生殖医学中心,广东,广州,510515
摘    要:目的 探讨体外受精(IVF)治疗中使用不同促性腺激素(Gn)剂量及卵巢反应性与临床结局的关系.方法 在接受IVF治疗、Gn用药时间≤15 d的患者中,共551个取卵周期按Gn用量和获卵数进行分组.A组Gn≥3375 IU.获卵数≥4个,390个周期;B组Gn≥3375IU,获卵数≤3个,64个周期;C组Cn≤3300IU及获卵数≤3个,97个周期.对3组的多个临床特征及治疗结局进行分析比较.结果 A组的临床妊娠率和分娩率分别为38.8%和32.5%,B组为16.7%和10.4%,C组为27.3%和23.4%.A组卵泡数、获卵数、可移植胚胎数、血清E2峰值、临床妊娠率和分娩率均高于B、C组(P<0.05).A、B组Gn用药剂量均较C组大(P<0.05),B组血清E2峰值、临床妊娠率和分娩率均低于C组.但差异无统计学意义(P0.05).结论 对Gn用量较低而取卵数少的患者,增加Gn用量能提高临床妊娠率和分娩率,这部分患者应视为相对的卵巢低反应者或轻度卵巢储备功能低下;而增加Gn用量后仍不能增加获卵数者,为真正的卵巢低反应者或重度卵巢储备功能低下,临床预后不佳.

关 键 词:促性腺激素  卵巢低反应  临床结局  体外受精  体外受精  治疗结局  促性腺激素  用药剂量  卵巢反应性  临床结局  关系  response  dose  embryo  transfer  in  vitro  fertilization  outcome  临床预后  重度  功能低下  卵巢储备  轻度  卵巢低反应者  统计学意义  差异
文章编号:1673-4254(2008)05-0712-03
修稿时间:2007年12月19

Gonadotrophin dose and ovarian response:relations to the clinical outcome of in vitro fertilization and embryo transfer
XIONG Xia-si,CHEN Shi-ling,SUN Ling,YIN Min-na,ZHAO Er-yong,SONG Juan Center for Reproductive Medicine.Gonadotrophin dose and ovarian response:relations to the clinical outcome of in vitro fertilization and embryo transfer[J].Journal of Southern Medical University,2008,28(5):712-714.
Authors:XIONG Xia-si  CHEN Shi-ling  SUN Ling  YIN Min-na  ZHAO Er-yong  SONG Juan Center for Reproductive Medicine
Institution:Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. xiongxiasi@sohu.com
Abstract:OBJECTIVE: To investigate the association of gonadotrophin (Gn) dose and ovarian response with the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET). METHODS: Patients undergoing IVF-ET with Gn stimulation for no more than 15 days were enrolled in this study. The patients were divided into 3 groups, namely group A (390 cycles) with total Gn dose :3375 IU and retrieved oocytes:4, group B (64 cycles) with total Gn dose :3375 IU and retrieved oocytes < or =3, and group C (97 cycles) with total Gn dose< or =3300 IU and retrieved oocytes< or =3. The clinical characteristics and outcomes of these 3 groups were comparatively analyzed. RESULTS: The clinical pregnancy rate and delivery rate were 38.8% and 32.5% in group A, 16.7% and 10.4% in group B, and 27.3% and 23.4% in group C, respectively. The follicle number, oocyte number, number of embryo transferred, peak serum E2 level, clinical pregnancy rate and delivery rate were significantly higher in group A than in groups B and C (P<0.05). Groups B and C had similar follicle number, oocyte number, and number of available embryos, but group C had significantly lower total Gn dose (P<0.05); the peak serum E2 level, clinical pregnancy rate and delivery rate were lower in group B than in group C, but the difference was not statistically significant (P>0.05). CONCLUSIONS: In patients receiving a relatively low dose of Gn with smaller number of retrieved oocytes, Gn dose increment can improve the clinical pregnancy rate and delivery rate, suggesting a state of relatively poor ovarian response or mild ovarian reserve decrease; failure of increasing the number of oocytes retrieved with greater Gn dose suggests severely decreased ovarian responsiveness or ovarian reserve and also poor clinical prognosis.
Keywords:gonadotrophin  poor responders  clinical outcome  IVF  
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