改良超长方案在卵巢储备功能低下高龄患者中的应用

目的:探讨改良超长方案行体外受精-胚胎移植(IVF-ET)助孕的高龄(年龄≥40岁)且卵巢储备功能低下(窦卵泡3~7个)患者的治疗结局。方法:采用随机对照前瞻研究的方法,将行IVF-ET的120例高龄且卵巢储备功能低下患者随机分成:改良超长方案组(A组,n=55)和拮抗剂方案组(B组,n=65),比较A、B组间IVF-ET结局。结果:A组的Gn使用总量(3 955.2±1194.3 IU)、Gn使用天数(11.7±1.9 d)、hCG注射日E2水平(2 452.7±1 285.6 pg/ml),hCG注射日子宫内膜厚度(12.1±2.3 mm)均明显高于B组(分别为2 022.5±610.1 IU、9.1±1.7 d、1 257.7±696.0 pg/ml、11.3±2.0 mm),P<0.05;周期取消率、优质胚胎率、妊娠率、着床率、流产率、宫外孕发生率组间均无统计学差异(P>0.05)。A组hCG注射日LH水平(1.0±0.5 mIU/ml)及P/E2值(0.3±0.2)明显低于B组(3.4±2.4 mIU/ml及0.5±0.2),P<0.05。结论:改良超长方案经过GnRHa的预处理,使患者充分降调节,hCG注射日可以获得良好的LH水平、P/E2值及内膜厚度;而hMG的使用,既可降低患者费用,又可以适当补充LH,提高子宫内膜容受性。因此,对于高龄且卵巢储备功能低下的患者,改良超长方案是一个经济有效的治疗选择。

Use of Modified Ultra-long Protocol in Elder Women with Low Ovarian Reserve

Objective: To compare IVF outcomes with ultra-long protocol and antagonist protocol in women of low ovarian reserve and advanced age(≥ 40 years old).Methods: A total of 120 patients aging over 40 years old with low ovarian reserve undergoing IVF(total number of AFC was 3-7) were prospectively randomized into 2 groups: group A,55 patients were down-regulated with two dosages of GnRHa(ultra-long protocol);group B,65 patients were subjected to flexible antagonist.All participants met the following inclusion criteria: with less than 3 cycles,with no uterine abnormalities and hydrosalpinges.Results: Gn dosage(3 955.2 ± 1 194.3 IU vs 2 022.5 ± 610.1 IU) and duration(11.7 ± 1.9 d vs 9.1 ± 1.7 d),E2level(2 452.7 ± 1 285.6 pg/ml vs 1 257.7±696.0 pg/ml) and endometrial thickness(12.1±2.3 mm vs 11.3±2.0 mm) on hCG injection day in group A were higher than those in group B.There were no significant differences in cancellation rate,the number of high-quality embryos,pregnancy rate,implantation rate,abortion rate and pregnancy rate between the two groups.The LH level(1.0 ± 0.5 mIU/ml) and P/E2ratio(0.3 ± 0.2) in group A were much lower than those in group B(3.4±2.4 mIU/ml,0.5±0.2).Conclusion: Abundant downregulation with modified ultra-long GnRHa protocol results in a satisfying LH level,P/E2 ratio and endometrial thickness.hMG used in ultra-long GnRHa protocol both decreases expenses and increases endometrial receptivity by supplying LH.Therefore,modified ultra-long GnRHa protocol is a cost-effective and proper choice to older women with low ovarian reserve.