不同促排卵方案来源胚胎冻融胚胎移植妊娠结局分析北大核心CSCD

目的探讨不同促排卵方案来源胚胎冻融胚胎移植(FET)的妊娠结局。方法回顾性分析2016年1月至2021年5月在南通大学附属医院生殖医学中心接受体外受精或卵泡浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗,因鲜胚移植失败或全胚冷冻而要求FET的252个周期,根据刺激周期方案的不同将其分为5组:高孕激素促排卵(PPOS)组(n=26)、枸橼酸氯米芬+人绝经期促性腺激素(CC+hMG)组(n=50)、超短方案组(n=57)、拮抗剂组(n=78)及长方案组(n=41),分析各组的临床结局。结果 252个FET周期中,各组体重指数(BMI)、不孕年限、不孕类型、刺激周期时扳机日E2水平/扳机日直径≥14mm卵泡数、移植周期时转化日内膜厚度、转化日E2水平、移植D3胚胎或囊胚比例,差别均无统计学意义(P>0.05)。各组间患者年龄、基础FSH、获卵数、刺激周期Gn总量及平均移植胚胎数,差异有统计学意义(P<0.05)。各组间hCG阳性率、临床妊娠率、流产率及继续妊娠率差异无统计学意义(P>0.05)。但CC+hMG组hCG阳性率、临床妊娠率及继续妊娠率数值上最低,长方案组hCG阳性率、临床妊娠率及继续妊娠率数值上均最高。多因素logistic回归分析发现CC+hMG组FET临床妊娠率低于长方案组,差别有统计学意义(P<0.05),但与其他各组比较差异无统计学意义。其他4组间比较妊娠结局无明显差异(P>0.05)。结论 PPOS、超短方案、长方案、拮抗剂促排卵方案来源胚胎FET妊娠结局在数值上优于CC+hMG促排卵方案,其中长方案显著优于CC+hMG促排卵方案。     

微刺激方案在常规IVF-ET治疗失败后卵巢低反应患者中的应用

目的:探讨微刺激方案在IVF-ET过程中对卵巢低反应患者的应用价值。方法:对56例卵巢低反应患者应用常规促排卵方案进行112个IVF周期治疗失败后改用微刺激方案的201个周期进行回顾性分析,比较使用这2种方案的治疗效果及临床结局,同时比较微刺激方案中使用与未使用GnRH-拮抗剂的临床数据与治疗结局。结果:112个常规促排卵周期中6个周期取消。106个周期取卵,95个周期获得卵母细胞,平均获卵数3.7±1.5个。共91个周期进行胚胎移植,均未获得妊娠。201个微刺激周期中17个周期取消,184个取卵周期中163个周期获得卵母细胞,平均获卵数3.4±1.4个。共160个周期进行胚胎移植,临床妊娠18例,双胎妊娠2例,流产3例,胚胎种植率为5.9%(20/336),起始周期临床妊娠率为9.8%(18/184),移植周期临床妊娠率为11.3%(18/160),累计继续妊娠率为26.8%(15/56)。比较前、后2种方案,常规促排卵方案中刺激时间为12.0±1.4 d,Gn使用总量为3 780±1 350 IU,远多于微刺激方案中的8.0±1.2 d和650±120 IU(P<0.05),而hCG注射日E2值(860±36 pg/ml vs 756±28 pg/ml)、平均获卵数(3.7±1.5 vs 3.4±1.4)、受精率(68.5%vs 64.5%)、优质胚胎率(56.7%vs 47.7%)2种方案均无显著性差异(P>0.05)。微刺激周期中使用拮抗剂组较未使用拮抗剂组周期取消率降低(4.5%vs 22.0%),hCG注射日LH值降低(2.3±1.1 U vs 7.8±2.4 U)(P<0.05),优质胚胎率(53.7%vs 25.7%)、胚胎着床率(6.5%vs3.9%)及临床妊娠率(12.3%vs 6.7%)均有增高的趋势,但差异均无统计学意义(P>0.05)。结论:微刺激方案对卵巢反应不良患者具有简便、疗程短、患者心理负担轻、医疗风险小等特点,值得推广应用,并建议联合拮抗剂使用。     

全部胚胎冷冻对不同促排卵方案患者临床应用的探讨

目的分析不同超促排卵方案新鲜胚胎移植和冻融胚胎移植的临床妊娠结局,探讨全部胚胎冷冻技术在临床应用中的价值。方法回顾性分析行胚胎移植的525个周期患者的临床资料,其中253个周期为新鲜胚胎移植周期,272个周期为同期的复苏胚胎移植周期。纳入的促排卵方案包括促性腺激素释放激素激动剂(GnRH-a)长方案组(A组)和GnRH-a短方案组(B组)。分别比较两组中新鲜胚胎移植和冻融胚胎移植(FET)的妊娠结局,以及新鲜胚胎移植周期和复苏胚胎移植周期中2种方案妊娠结局。结果 A组中,新鲜胚胎移植周期(A1组)和FET周期(A2组)的临床妊娠率分别为45.95%和47.71%(P0.05);B组中,新鲜胚胎移植周期(B1组)和FET(B2组)的临床妊娠率分别为27.94%和46.30%(P0.05);A1组和B1组的受精率和可用胚胎率组间无统计学差异(P0.05),A组的平均获卵数、临床妊娠率和胚胎种植率显著高于B组(P0.05);A2组和B2组的临床妊娠率和胚胎种植率均无统计学差异(P0.05)。结论 FET并不能显著改善长方案患者的临床妊娠结局,但可显著提高短方案组的临床妊娠率,提示短方案患者可考虑采用全部胚胎冷冻。     

来曲唑微刺激方案和短方案对卵巢低反应助孕的临床研究

目的:探讨卵巢低反应助孕患者在进行体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗中来曲唑(LE)微刺激方案和短方案的应用.方法:回顾性分析进行IVF/ICSI-ET治疗的卵巢低反应患者共206个周期.按治疗方案分短方案组(97周期)和微刺激组(109周期),分别比较两组患者的一般情况、促排卵情况及妊娠结局等.结果:短方案组的促性腺激素(Gn)用量、Gn刺激天数、HCG注射日雌激素(E2)值、≥16 mm卵泡数等均高于微刺激组,差异有统计学意义(P＜0.05).而两组成熟率、正常受精率、卵裂率、周期取消率、生化妊娠率及临床妊娠率比较,差异无统计学意义(P＞0.05),但微刺激组的优质胚胎率显著高于短方案组(P＜0.01).结论:来曲唑微刺激方案是卵巢反应低下患者较理想的促排卵方案.     

高效孕激素下超促排卵和微刺激方案在卵巢功能减退患者中应用效果分析

目的探讨高效孕激素下超促排卵(PPOS)和微刺激两种方案在卵巢功能减退患者(DOR)中的促排卵效果和全胚冷冻后行冻融胚胎移植(FET)的临床妊娠结局的差异。方法对2015年12月至2016年7月在郑州大学第二附属医院行体外受精-胚胎移植(IVF-ET)辅助生殖技术的431例卵巢储备功能下降患者的资料进行回顾性分析,其中PPOS方案组209例,微刺激组222例,比较两组的促排卵实验室结局和全胚冷冻后FET的妊娠结局。采用多因素Logistic回归校正混杂因素后比较两种促排卵方案的临床妊娠率。结果 PPOS组扳机日促黄体生成素(LH)水平低于微刺激组[3.63(2.40,5.46)U/L vs.7.07(4.04,11.92)U/L,P0.05],PPOS组取消取卵率低于微刺激组(1.44%vs.7.21%,P0.05),PPOS组获卵数、可利用胚胎数和优质胚胎数均高于微刺激组(P0.05)。全胚冷冻后行复苏移植,PPOS组临床妊娠率(29.17%)和胚胎着床率(14.63%)略高于微刺激组(19.70%和12.59%,P0.05)。多因素Logistic回归分析结果显示:PPOS方案可以获得更高的临床妊娠率(OR=6.79,95%CI 1.15~40.06,P=0.035)。结论对于DOR患者,PPOS方案较微刺激方案可减少取消取卵率,并可获得更多的获卵数、可利用胚胎数和优质胚胎数,累积胚胎提供更多移植机会。PPOS方案可作为DOR患者行IVF-ET辅助生殖技术时促排卵方案的一种选择。     

微量GnRH-a长方案和短方案在≥35岁不孕患者IVF/ICSI-ET中临床结局的比较

目的:比较高龄不孕女性体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)中微量短效Gn RH-a长方案及常规短方案的促排卵效果及临床结局。方法:回顾性分析602例≥35岁不孕患者682个周期IVF/ICSI-ET临床结局,按促排卵方案分为微量短效Gn RH-a长方案组(172个周期,A组)和常规短方案组(510个周期,B组),再以年龄段分层(35~37岁,38~39岁及≥40岁),分别比较不同年龄段两种促排卵方案的效果及临床结局。结果:A组Gn用量、Gn使用天数显著高于B组(P0.05),MII卵数、优质胚胎率、胚胎移植数、周期取消率均无统计学差异(P0.05);A组与B组相比,临床妊娠率、活产率(36.1%vs 29.8%;28.5%vs 23.3%;P0.05)有改善趋势;尤其在35~37岁及38~39岁患者中,A组优质胚胎率、临床妊娠率、活产率(52.89%vs 47.16%,50.14%vs47.97%;41.7%vs 36.7%,36.4%vs 22.2%;35.0%vs 29.2%,24.2%vs 15.7%;P均0.05)均有明显改善趋势。结论:≥35岁不孕女性微量Gn RH-a长方案临床结局有改善趋势,可作为高龄不孕女性,尤其是35~39岁不孕患者的有效促排卵方案之一。     

IVF/ICSI-ET技术中单卵双胎的发生及其相关因素

目的:探讨潜在的可能导致体外授精/卵胞质内单精子注射-胚胎移植(IVF/ICSIET)技术单卵双胎(MZT)高发生率的因素及其可能机制。方法:回顾性分析行IVF/ICSI-ET的2 885个周期,其中新鲜胚胎移植2 184个周期(常规IVF-ET周期1 473个,ICSI周期711个)和冻融胚胎移植(FET)周期701个,统计各个周期MZT妊娠的发生率,并分析可能影响其发生的相关因素。结果:在2 885个周期中临床妊娠1 102例,多胎妊娠的发生率为20.78%(229/1 102),其中MZT(双绒毛膜双胎及单绒毛膜双胎)妊娠20例,占临床妊娠的1.81%(20/1 102),占多胎的8.73%(20/229)。MZT中单卵双绒毛膜双胎5例,占MZT的25%(5/20),单卵单绒毛膜双胎15例,占MZT的75%(15/20)。ICSI中MZT的发生率为1.76%(5/284),高于常规IVF-ET周期(1.56%,9/575),但无统计学差异(P0.05)。FET组701个周期中临床妊娠243个周期,多胎34例,MZT 6例,占多胎发生率的17.65%(6/34);新鲜移植的2 184个周期中临床妊娠859个周期,多胎195例,MZT 14个周期,占多胎发生的7.18%(14/195),FET组和新鲜周期移植组间多胎率有统计学差异(P0.05)。囊胚移植204个周期中妊娠95例,多胎12例,MZT3例,占多胎发生的25%(3/12),非囊胚移植2 681个周期中妊娠1 007例,多胎217例,MZT 17例,占多胎发生的7.83%(17/217),囊胚移植组与非囊胚移植组间多胎率有统计学差异(P0.05)。冻融囊胚移植发生MZT的几率显著高于冻融非囊胚移植(P0.05)。IVF-ET中MZT妊娠与非MZT妊娠患者的年龄、促排卵方案、促排卵天数、促性腺激素(Gn)剂量与时间、优质胚胎数、移植胚胎数之间均无统计学差异(P0.05)。结论:MZT的发生率IVF/ICSI-ET明显高于自然妊娠;冻融囊胚移植明显高于冻融非囊胚移植,这可能与体外培养条件和冷冻复苏技术的应用有关,使其透明带硬度有所增加,致使囊胚在孵出时较易嵌顿,从而导致了MZT的发生。单纯显微授精技术不会明显增加MZT的发生率。     

超短方案在高龄体外受精患者中的应用

目的探讨超短方案在高龄患者进行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)中的疗效。方法回顾性分析326例年龄38岁女性的IVF-ET周期的临床资料,根据不同促排卵方案分为超短方案组和微刺激方案组。比较和分析2种促排卵方案的疗效。结果超短方案组的获卵数(5.8±0.3)、正常受精数(3.5±0.2)、优质胚胎数(2.5±1.8)和有效胚胎数(2.6±0.2)均高于微刺激方案组(2.4±0.1,1.5±0.1,1.0±1.0,1.7±0.1)(P0.001);患者的卵裂率和优质胚胎率组间无统计学差异(P0.05)。但超短方案组每取卵周期累积妊娠率(40.00%)和累积活产率(8.41%)均高于微刺激方案组(30.00%,7.52%)(P0.001),新鲜胚胎移植取消率(47.00%)明显低于微刺激方案组(99.56%)(P0.001)。结论对于高龄IVF患者进行促排卵时使用超短方案,可以获得更多的卵母细胞和有效胚胎,增加每取卵周期的累积妊娠率和活产率,并且通过降低新鲜胚胎移植取消率,减少患者的心理负担,对于高龄IVF患者是一种比较好的选择。     

解冻周期序贯移植在反复种植失败患者中的应用

目的探讨胚胎序贯移植法是否能够提高反复种植失败(recurrent implantation failure,RIF)患者的临床妊娠率。方法回顾性分析128例行常规体外受精或卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的RIF患者,按不同的移植法分为3组:解冻周期序贯移植36例,卵裂期移植45例,囊胚期移植47例。分析比较3组患者一般资料及胚胎和妊娠结局。结果解冻周期序贯移植组临床妊娠率(72.2%)及持续妊娠率(69.4%)明显高于卵裂期胚胎移植组(44.4%,37.8%)及囊胚期胚胎移植组(48.9%,44.7%),差异有统计学意义(P0.05)。结论解冻周期序贯移植法能够有效提高RIF患者的妊娠率,对于RIF患者序贯移植可作为一种有效的可供选择的移植手段,该方案避免了取消移植的可能性并对有较多移植胚胎数的患者有效。     

全胚冷冻再行解冻胚胎移植周期的临床结局分析

目的:探讨新鲜移植周期与冻融胚胎移植(FET)周期妊娠结局的差异。方法:回顾性分析本中心刺激周期行新鲜胚移植(190例)和全部胚胎冷冻后再行FET(97例)周期的临床妊娠率、种植率以及流产率。结果:190例刺激周期新鲜胚胎种植后的妊娠率、种植率、流产率分别为47.4%(90/190)、30.2%(103/341)、10.0%(9/90),97例全部胚胎冷冻后行FET后的妊娠率、种植率、流产率分别为60.8%(59/97)、47.0%(86/183)、10.2%(6/59),组间妊娠率与种植率均有统计学差异(P<0.05),流产率无统计学差异(P>0.05)。结论:对于有OHSS风险等不适宜进行新鲜胚胎移植的患者,选择全部胚胎冷冻并择期进行FET,并不降低胚胎种植率和临床妊娠率,从而预防迟发型OHSS的发生,可获得更为理想的妊娠结局。     

Embryo implantation rates in natural and stimulated assisted reproduction treatment cycles in poor responders

Controlled ovarian stimulation with exogenous gonadotrophins and gonadotrophin-releasing hormone (GnRH) analogues enables the collection of multiple oocytes and subsequent development of multiple embryos. However, interfering with the natural hormonal milieu may decrease the probability of successful embryo implantation due to effects on oocytes and/or endometrium. In order to provide a fair comparison of embryo implantation rates between natural cycles and stimulated cycles, bias caused by the presence of multiple embryos available for transfer in stimulated cycles should be avoided. This retrospective study analysed embryo implantation rates in cycles in which only a single embryo was available for transfer in 304 women who had poorly responded to ovarian stimulation in the previous cycle. Embryo implantation rates with different stimulation protocols were as follows: natural cycle, 20% (6/30); gonadotrophin only, 5.6% (3/54); long GnRH protocol, 3.8% (2/52); co-flare protocol, 1.9% (1/52); microdose flare-up, 15.4% (4/26); GnRH antagonists, 14.4% (13/90). Although the difference was not statistically significant there was a trend towards higher implantation rates with natural cycles in this group of women. Natural cycle IVF may be a reasonable and patient-friendly treatment choice yielding an acceptable outcome for women who are known or anticipated poor responders to ovarian stimulation.     

卵巢正常反应不孕症患者体外受精不同长方案促排卵效果的研究

目的探讨卵巢正常反应不孕症患者体外受精/卵胞质内单精子显微注射(IVF/ICSI)促排卵时应用口服避孕药(OC)长方案和黄体中期长方案的促排卵效果及临床结局。方法选择接受长方案IVF/ICSI助孕的卵巢正常反应患者共4 677个周期;根据年龄分为≤35岁组和35岁组,不方便超声监测排卵或自然周期超声监测卵泡不破裂的患者共2 762个周期,应用OC长方案(OC组);自然周期超声监测正常排卵的患者共1 915个周期,应用黄体中期长方案(黄体中期组);常规行IVF/ICSI,比较上述不同年龄人群2种促排卵方案的临床和实验室相关指标。结果 (1)OC组促性腺激素(Gn)启动日雌二醇(E2)[≤35岁组:(24.63±10.62)ng/L,35岁组:(24.24±10.40)ng/L]和促黄体生成素(LH)水平[≤35岁组:(0.92±0.59)IU/L,35岁组:(0.82±0.66)IU/L]均明显低于黄体中期组[≤35岁组:(25.89±12.80)ng/L,35岁组:(25.71±10.93)ng/L;≤35岁组:(1.37±0.59)IU/L,35岁组:(1.01±0.70)IU/L](P0.05);(2)OC组人绒毛膜促性腺激素(h CG)注射日E2水平[≤35岁组:(4 143.8±2 769.9)ng/L,35岁组:(3 597.5±2 160.4)ng/L]和因卵巢过度刺激综合征(OHSS)行全胚冷冻率(≤35岁组:9.1%,35岁组:10.2%)均明显高于黄体中期组[≤35岁组:(3 850.8±2 092.4)ng/L,35岁组:(3 213.4±1 804.5)ng/L;≤35岁组:4.9%,35岁组:5.9%](P0.05),但h CG注射日的内膜厚度[≤35岁组:(10.75±2.25)mm,35岁组:(10.47±2.38)mm]却明显小于后者[≤35岁组:(11.62±2.43)mm,35岁组:(11.09±2.68)mm](P0.05);(3)在年龄35岁的OC组Gn总用量[(3 775.4±1 200.0)IU]和使用时间[(13.5±2.2)d]明显高于黄体中期组[(3 516.9±1 156.1)IU,(12.4±2.2)d](P0.05);(4)2种降调节方案患者的获卵数、ICSI成熟卵数、双原核(2PN)受精率、平均移植胚胎数、优质胚胎率和早期流产率均无明显差异(P0.05),但OC组的着床率(≤35岁组:41.4%,35岁组:25.5%)和临床妊娠率(≤35岁组:55.7%,35岁组:37.5%)明显小于黄体中期组(≤35岁组:46.7%,35岁组:31.4%;≤35岁组:65.6%,35岁组:46.9%)(P0.05)。结论 (1)OC长方案可加深垂体抑制,尤其是35岁的高龄患者需增加Gn用量才能达到与黄体中期长方案相似的促排卵效果;(2)OC长方案可能通过影响子宫内膜厚度及容受性而降低着床率和临床妊娠率;(3)OC长方案使h CG注射日E2水平更高,易诱发OHSS的发生。故对卵巢功能正常的不孕患者,IVF/ICSI助孕时尽量选择黄体中期长方案。     

3种控制性促排卵方案治疗卵巢反应不良效果的比较

目的:探讨3种控制性促排卵方案治疗卵巢反应不良年轻患者的效果。方法:回顾分析2009年6月至2011年7月在中山大学附属第一医院生殖中心行辅助生育治疗、年龄30～40岁、出现2次及以上卵巢反应不良周期患者的所有周期共240个,选取其中标准GnRH激动剂长、短及拮抗剂方案共220个周期。在220个周期中GnRH激动剂长方案86个周期为长方案组、短方案83个周期为短方案组、拮抗剂方案51个周期为拮抗剂方案组。比较3组病例的临床资料、实验室资料和妊娠结局,评估不同促排卵方案治疗卵巢反应不良的结果。结果:短方案组基础FSH高于长方案组(P=0.039),但Gn总量少于长方案组(P=0.000),两组胚胎质量及妊娠结局的差异无统计学意义。短方案组基础FSH与拮抗剂方案组的差异无统计学意义,虽然Gn使用量高于拮抗剂方案组(P=0.000),但获卵数亦高于拮抗剂方案组(P=0.001),且周期取消率低于拮抗剂方案组(P=0.013)。3组其他临床资料(年龄、不孕年限等)、受精数、受精率、可利用胚胎率、胚胎种植率及妊娠结局等差异均无统计学意义(P>0.05)。比较添加生长激素对长、短方案获卵数的影响,差异无统计学意义(P>0.05)。结论:GnRHa短方案用于小于40岁的卵巢反应不良患者的促排卵效果较优。     

Serum CA-125 and inhibin B levels in the prediction of ovarian response to gonadotropin stimulation in in vitro fertilization cycles.

There is much controversy about the relationship between serum CA-125 levels during in vitro fertilization (IVF) cycles and ovarian function. To evaluate the prognostic value of serum CA-125 and inhibin B measurements in predicting ovarian response to gonadotropin stimulation, we compared the CA-125 and inhibin B levels of poor and normal responders on the first day of ovarian stimulation, on the day of ovulation induction (OI) and at oocyte pick-up. Sixteen patients with poor ovarian response (3 oocytes, serum estradiol (E2) 900 pg/ml at OI) in IVF/intracytoplasmic sperm injection cycles were matched with normal responders (6 oocytes, E2 1800 pg/ml) by age, spontaneous cycle day-3 follicle-stimulating hormone level and cause of infertility. Inhibin B concentrations were significantly lower at all three time points in poor responders, but CA-125 levels were not. No statistically significant correlation was found between CA-125 levels and any of the clinical or laboratory parameters examined. Thus, CA-125 measurements during stimulation are not useful in predicting or identifying poor ovarian response to gonadotropin stimulation in IVF cycles. The lack of difference in CA-125 concentrations between poor and normal responders and lack of correlation with E2 or inhibin B levels suggest that ovarian steroidogenesis and other granulosa cell functions do not influence the production of CA-125. Inhibin B, however, seems to predict ovarian response as early as at the start of stimulation.     

超短方案在卵巢低反应患者中的应用

目的:探讨体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)周期中,超短方案在卵巢低反应患者(poor ovarian responders,PORs)中的应用。方法:回顾性分析342例PORs的401个IVF周期,根据促排卵方案不同分为超短方案组(A组,254例,291个周期)和微刺激方案组(B组,88例,110个周期)。比较A、B组的一般资料、妊娠结局以及周期取消率等指标,分析A、B组周期取消原因。结果:临床妊娠率/移植周期、种植率和流产率组间均无统计学差异(P>0.05),但A组累积妊娠率显著高于B组(25.1%vs 14.5%,P<0.05),周期取消率显著低于B组(17.5%vs 44.5%,P<0.05)。周期取消原因分析表明,微刺激组因内膜因素取消移植的比例显著高于超短方案组(22.4%vs 7.8%,P<0.05)。结论:在PORs中,超短方案周期取消率低,患者心理压力小,整个疗程耗时短。因此超短方案也是PORs可以选择的、较理想的促排卵方案。     

Comparison of clinical outcomes among dual ovarian stimulation,mild stimulation and luteal phase stimulation protocols in women with poor ovarian response

This study aimed to determine whether consecutive ovarian stimulation in follicular and luteal phases within a single menstrual cycle (dual stimulation) is achievable and superior to conventional stimulation for poor ovarian responders (PORs). Data of 260 PORs were retrospectively collected and divided into three groups. Group A comprised of cycles with dual ovarian stimulation (n?=?76), which were divided into two subgroups (follicular [group A-F] and luteal phase stimulation [group A-L]); group B comprised of cycles with ovarian stimulation that was performed only in the luteal phase (n?=?52). Group C comprised of mild ovarian stimulation cycles (n?=?132). Baseline parameters were not different among the three groups. The numbers of oocytes and embryo obtained were less in group A-F than group B and C, while group A overall had significantly more oocytes and viable embryo retrieved than did group B and C. Group A-L consumed significantly less gonadotropin than group B, without compromising the number of retrieved oocytes and embryo. The pregnancy outcomes of transfer of embryo from different stimulation phases were similar. We conclude that dual ovarian stimulation protocol is effective and potentially optimal for PORs.     

卵巢反应低下患者辅助生殖技术促排卵方案的对比分析

目的:通过比较卵巢反应低下(POR)患者在进行辅助生殖技术(ART)治疗中几种促排卵方案的治疗结局,探讨针对POR患者经济有效、个性化的促排卵方案。方法:回顾性分析行体外受精/卵细胞浆内单精子注射(IVF/ICSI)治疗的POR患者共302个周期,按不同促排卵方案分为4组:超短方案组(43个周期),短方案组(30个周期),氯米芬联合尿促性素微刺激方案组(CC+HMG组,62个周期),卵泡期尿促性素联合甲羟孕酮方案组(HMG+MPA组,167个周期)。对4组患者的促排卵情况、周期取消情况及每起始周期的临床结局进行比较。结果:(1)4组患者ART周期中Gn天数、Gn用量、药费、扳机日优势卵泡数、获卵率、性价比比较,差异有统计学意义(P0.05);其中,超短方案组的Gn天数最长,Gn用量最多;短方案组扳机日优势卵泡数最多,完成1次治疗周期的药费最贵,相对取得1个可移植胚胎的性价比最差;CC+HMG组的Gn天数最短、Gn用量最少,但扳机日优势卵泡数最少,获卵率也最低;HMG+MPA组药费最低,获卵率最高,性价比最好。(2)在取消周期方面,4组间因异常受精及未受精、未卵裂、无可移植胚胎、无优质胚胎而取消周期的差异无统计学意义(P0.05)。CC+HMG组及超短方案组的未获卵周期率高于短方案组及HMG+MPA组(P0.05)。(3)4组方案每起始周期的临床妊娠率、着床率比较,差异无统计学意义(P0.05)。HMG+MPA组的流产率低于CC+HMG组(P0.05);HMG+MPA组每起始周期的继续妊娠率高于超短方案组与CC+HMG组(P0.05)。结论:卵泡期HMG+MPA方案可能是POR患者的一种经济的、有效的、有利于患者的促排卵方案。     

The prognostic importance of the number of oocytes retrieved and estradiol levels in poor and normal responders in in vitro fertilization (IVF) treatment

A low response to ovarian stimulation in in vitro fertilization poses a unique therapeutic challenge. Gonadotropin-releasing hormone agonists (GnRHa) have been suggested as a modality for treatment of this condition. In this study, we analyzed the results of 880 in vitro fertilization treatment cycles with respect to modality of ovarian stimulation, degree of hormonal response, and number of oocytes retrieved. In patients with estradiol (E ₂ )levels less than 501 pg/ml on the day of human chorionic gonadotropin administration, 27% pregnancy rate was achieved with clomiphene citrate (CC) combined with human menopausal gonadotropin (hMG), compared to 15.1% (P <0.005) with hMG alone and 20.8% (NS) with GnRHa and hMG. Pregnancy rates were not lower in these patients compared to patients with higher estradiol levels in the different stimulation protocols, but pregnancy rates were significantly lower in cycles during which three or fewer oocytes were retrieved, compared to those in which four or more oocytes were retrieved (10.8 vs 23.8%; P <0.0005). In low-retrieval cycles pregnancy rates actually decreased with increasing levels of estradiol. Our results indicate that the number of oocytes retrieved is a better prognostic parameter than E ₂ levels in predicting the outcome of in vitro fertilization treatment and that GnRHa in the long protocol do not seem to be superior to CC combined with hMG for the treatment of poor responders.     

Serum CA-125 and inhibin B levels in the prediction of ovarian response to gonadotropin stimulation in in vitro fertilization cycles

There is much controversy about the relationship between serum CA-125 levels during in vitro fertilization (IVF) cycles and ovarian function. To evaluate the prognostic value of serum CA-125 and inhibin B measurements in predicting ovarian response to gonadotropin stimulation, we compared the CA-125 and inhibin B levels of poor and normal responders on the first day of ovarian stimulation, on the day of ovulation induction (OI) and at oocyte pick-up. Sixteen patients with poor ovarian response (???3 oocytes, serum estradiol (E₂) ??900?pg/ml at OI) in IVF/intracytoplasmic sperm injection cycles were matched with normal responders (???6 oocytes, E₂ ??1800?pg/ml) by age, spontaneous cycle day-3 follicle-stimulating hormone level and cause of infertility. Inhibin B concentrations were significantly lower at all three time points in poor responders, but CA-125 levels were not. No statistically significant correlation was found between CA-125 levels and any of the clinical or laboratory parameters examined. Thus, CA-125 measurements during stimulation are not useful in predicting or identifying poor ovarian response to gonadotropin stimulation in IVF cycles. The lack of difference in CA-125 concentrations between poor and normal responders and lack of correlation with E₂ or inhibin B levels suggest that ovarian steroidogenesis and other granulosa cell functions do not influence the production of CA-125. Inhibin B, however, seems to predict ovarian response as early as at the start of stimulation.