来曲唑联合卵泡期高孕激素促排卵对高龄患者IVF/ICSI妊娠结局的影响

目的探讨在高龄患者行IVF/ICSI过程中应用卵泡期高孕激素促排卵(PPOS)方案联合来曲唑(LE)对妊娠结局的影响。方法回顾性分析2016年6月至2018年9月在我院生殖中心行IVF/ICSI助孕治疗的318个周期的临床资料。根据是否在PPOS方案早卵泡期应用LE进行分组,PPOS早卵泡期应用LE者为A组(n=120)和不应用LE者为B组(n=198),比较两组患者的一般情况和妊娠结局。结果A组患者在诱发排卵日血清E 2水平显著低于B组(1730.55±1570.02)pmol/L vs.(2910.56±2084.52)pmol/L,P<0.05],而促性腺激素(Gn)使用天数及Gn用量显著高于B组分别为(8.91±3.62)d vs.(7.83±2.72)d;(2245±1079)U vs.(1934±842)U,P<0.05];两组患者间获卵数、成熟卵子数、可利用胚胎数和周期取消率比较差异均无统计学意义(P>0.05);A组受精率显著低于B组(58.82%vs.69.71%,P<0.05);冻融胚胎移植后两组患者的累积妊娠率(20.85%vs.27.73%)和累积分娩率(11.69%vs.16.71%)均无显著差异(P>0.05)。结论应用PPOS方案促排卵时联合应用LE并不影响高龄患者IVF/ICSI的妊娠结局;应用LE导致的诱发排卵日E 2降低并不影响获卵数及可利用胚胎数。

Effect of letrozole combined with progestin-primed ovarian stimulation during follicular phase on pregnancy outcome of IVF/ICSI in elderly patients

Objective:To explore the effect of applying letrozole(LE)combine with progestin-primed ovarian stimulation(PPOS)in follicular phase on the pregnancy IVF/ICSI outcome in elderly patients.Methods:The clinical data of 318 IVF/ICSI cycles performed in the reproductive center of our hospital from June 2016 to September 2018 were retrospectively analyzed.According to whether LE was used in the early follicular phase of the PPOS protocol,the cycles were divided to two groups:the cycles used LE in the early follicular phase in group A(n=120)and those did not use LE in group B(n=198).The general condition and pregnancy outcome were compared between the two groups of patients.Results:The serum E 2 levels on the day of ovulation induction of the patients in group A were significantly lower than those in group B(1730.55±1570.02)pmol/L vs.(2910.56±2084.52)pmol/L,P<0.05],while gonadotropin(Gn),number of days and the dosage of Gn used were significantly higher than those in group B(8.91±3.62)days vs.(7.83±2.72)days;(2245±1079)U vs.(1934±842)U,P<0.05].There was no significant difference in the number of oocytes retrieved,number of mature oocytes and available embryos,and cycle cancellation rate between the two groups(P>0.05).The fertilization rate of group A was significantly lower than that of group B(58.82%vs.69.71%,P<0.05),but the cumulative pregnancy rate(20.85%vs.27.73%)and cumulative delivery rate(11.69%vs.16.71%)were not significantly different(P>0.05).Conclusions:The application of LE combined with PPOS protocol to induce ovulation does not affect the pregnancy outcome of IVF/ICSI in elderly patients.The decrease of E 2 level on the day of ovulation induced by application of LE does not affect the number of oocytes retrieved and the number of available embryos.