微刺激促排卵方案在体外受精-胚胎移植中的应用

目的研究微刺激促排卵方案在体外受精-胚胎移植（IVF-ET）中的应用。方法将351例不孕患者分为卵巢正常反应组（n=225）及卵巢反应不良组（n=126）。以上2组再各分为微刺激促排卵方案试验组及常规促排卵方案对照组。比较各组的促排卵治疗结果和临床结局。结果卵巢正常反应组中常规促排卵组的Gn天数、Gn支数、获卵数显著多于微刺激组（P〈0.05）,卵巢反应不良组中常规组的Gn天数、获卵数、HCG日内膜厚度与微刺激组无显著性差异（P〉0.05）,常规组的Gn支数显著多于微刺激组（P〈0.05）。卵巢正常反应组中常规组的临床妊娠率、种植率、双胎率、中重度OHSS发生率均显著高于微刺激组（P〈0.05）,宫外孕率、流产率、受精率、卵裂率、优胚率无显著性差异（P〉0.05）。卵巢反应不良组中常规组的临床妊娠率、种植率、宫外孕率、流产率、双胎率、受精率、卵裂率、优胚率与微刺激组均无显著性差异（P〉0.05）,中重度OHSS发生率均为0。结论微刺激促排卵方案在不影响临床妊娠率的前提下能明显减少Gn量,节省了大量的费用,对于卵巢反应不良患者使用微刺激方案更佳。

Minimal ovarian stimulation for IVF-ET

Objective To study the application of milder stimulation protocols in in vitro fertilization and embryo transfer（IVFET） programs.Methods A total of 351 infertile patients with normal ovarian response（n=225）and poor ovarian response（n=126）,then the two groups respectively grouped as mild stimulation trial group and routine ovulation induction control group.To compare the therapy result of promoting ovulation and the clinical outcome in each group.Results There was a significant difference between the control group and the treatment group in the normal ovarian response on the duration and the total dose of gonadotropin and the number of retrieved oocytes（P0.05）;and there was no significant difference between the two groups in the poor ovarian response on the duration of gonadotropin,the number of retrieved oocytes,and the endometrium thickness at HCG administration（P0.05）,while the total dose of gonadotropin was significantly increased than the treatment group（P0.05）.The clinical pregnancy rate,implantation rate,twinning rate,and the incident rate of moderate and severe OHSS（ovarian hyperstimulation syndrome）was significant higher than the control group in the treatment group（P0.05）,and there was no significant difference between the two groups on ectopic pregnancy rate,abortion rate,fertility rate,cleavage rate and the high-quality embryonic rate（P0.05）.There was no significant difference between the two groups in the poor ovarian response on the clinical pregnancy rate,implantation rate,ectopic pregnancy rate,abortion rate,twinning rate,fertility rate,cleavage rate,and the high-quality embryonic rate（P0.05）,and the incident rate of moderate and severe OHSS was 0%.Conclusion The milder stimulation protocols can significantly decrease the total dose of gonadotropin,and save a lot of money by the premise of reduce clinical pregnancy rate,and it＇s a better choose for the poor ovarian response infertile patients.