高孕激素下促排卵方案在子宫内膜异位症卵巢储备功能降低患者中的应用分析

目的探讨高孕激素下促排卵方案(PPOS方案)在子宫内膜异位症合并卵巢储备功能降低(DOR)患者中的应用价值。方法回顾性分析2017年7月至2020年3月因子宫内膜异位症合并DOR于我院接受“养精蕴育”中医治疗并行IVF/ICSI-ET助孕的136例患者的临床资料,其中有9例患者采用了PPOS方案和降调节方案两次促排卵,故将此9例患者单独列出行前后资料比较。其余127例患者(127个周期)根据促排卵方案的不同分为2组:PPOS组(86个周期),降调节组(41个周期)。比较两组患者的促排卵情况及妊娠结局,并比较两组中行冻融胚胎移植(FET)的周期资料。结果PPOS组和降调节组的一般资料比较均无显著性差异(P>0.05)。PPOS组的获卵数(5.84±1.66)vs.(4.44±2.11)]显著高于降调节组,MⅡ卵率(63.87%vs.83.89%)、卵裂率(77.39%vs.86.13%)、平均移植胚胎数(1.70±0.41)vs.(1.90±0.28)]均显著低于降调节组(P<0.05)。两组的Gn天数、Gn用量、受精率、优质胚胎率、无胚可移率、中重度OHSS发生率、胚胎种植率、异位妊娠率、多胎率、早期流产率、临床妊娠率及活产率均无显著性差异(P>0.05)。两组患者FET周期参数比较,达菲林用药量(支)、移植日内膜厚度、移植胚胎数、临床妊娠率、胚胎种植率、流产率、异位妊娠率及活产率均无显著性差异(P>0.05)。9例患者前后两次促排卵的Gn天数、Gn用量、获卵数、MⅡ卵率、受精率、卵裂率、优胚率及无胚可移率比较均无显著性差异(P>0.05)。结论对于子宫内膜异位症合并DOR的患者,采用PPOS方案促排卵可获得与降调节方案相似的妊娠结局,PPOS方案可作为这类患者促排卵方案的选择之一。

Analysis of outcomes of progestin primed ovarian stimulation in endometriosis patients with diminished ovarian reserve

Objective:To explore application value of progestin primed ovarian stimulation(PPOS)protocol in patients with endometriosis complicated with diminished ovarian reserve(DOR).Methods:The clinical rata of 136 patients who were treated with traditional Chinese medicine“YangJing YunYu”and underwent IVF/ICSI-ET treatment in our center from July 2017 to March 2020 were retrospective analyzed.Among them,9 patients received PPOS and down-regulation protocol for ovulation induction twice.Therefore,the two results of ovulation induction in these 9 patients were compared separately.The remaining 127 patients(127 cycles)were divided into two groups according to different ovulation induction protocols:PPOS group(86 cycles)and down-regulation group(41 cycles).The ovulation induction and pregnancy outcome of the two groups were compared,and the data of frozen-thawed embryo transfer(FET)cycles were compared between the two groups.Results:There was no significant difference in the general data between the PPOS group and the down-regulation group(P>0.05).The number of oocytes retrieved in the PPOS group(5.84±1.66)vs.(4.44±2.11)]was significantly higher than that of down-regulation group(P<0.05),but MⅡoocyte rate(63.87%vs.83.89%),cleavage rate(77.39%vs.86.13%)and average number of embryos transferred(1.70±0.41)vs.(1.90±0.28)]were significantly lower than those in the down-regulation group(P<0.05).There were no significant differences in Gn days,Gn doses,fertilization rate,high-quality embryo rate,no embryo transfer rate,moderate to severe OHSS incidence,implantation rate,ectopic pregnancy rate,multiple birth rate,early abortion rate,clinical pregnancy rate and live birth rate between the two groups(P>0.05).There were no significant differences in FET cycle parameters,including Diphereline dosage,endometrial thickness on the day of transplantation,number of transferred embryos,clinical pregnancy rate,embryo implantation rate,abortion rate,ectopic pregnancy rate and live birth rate between the two groups(P>0.05).There was no significant difference in Gn days,Gn doses,number of oocytes retrieved,MⅡoocyte rate,fertilization rate,cleavage rate,good-quality embryo rate and no embryo transfer rate between the two ovulation inductions in 9 patients(P>0.05).Conclusions:The PPOS protocol can achieve the similar pregnancy outcome as the down-regulation protocol for patients with endometriosis patients with diminished ovarian reserve.PPOs protocol can be used as one of the options for ovulation induction in such patients.