促排卵启动时间对子宫内膜异位症妇女体外受精妊娠结局的影响

目的探讨改良超长方案中根据降调节后的血清E_2水平选择合适的促性腺激素(Gn)启动时间在子宫内膜异位症(EMS)妇女体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)的临床应用。方法对98例IVF/ICSI-ET周期进行回顾性分析,改良超长方案治疗的65例为实验组,根据不孕因素分为A组(EMS性不孕)和B组(非EMS性不孕),A、B组均根据血清E_2水平选择恰当的时机启动Gn;另外行常规超长方案治疗的33例为对照组(C组,EMS性不孕),比较各组临床指标的差异。结果 (1)A组Gn使用总量[(2 330.4±747.8)IU]明显小于B组[(3 338.7±1 341.5)IU](P0.05),A组的受精率(77.6%)明显高于B组(65.8%)(P0.05),获卵数、妊娠率有增加趋势,但无统计学差异(P0.05)。(2)A组Gn起始剂量[(192.0±35.3)IU]、使用总量[(2 330.4±747.8)IU]均显著低于C组[(228.8±48.9)IU,(2 828.5±1 129.0)IU](P0.05),A组的启动时间[(35.9±7.4)d]明显大于C组[(28.0±0.0)d](P0.05),A组获卵数(8.8±4.7)也显著高于C组(6.1±3.9)(P0.05),两组的受精率、优质胚胎率、妊娠率均无统计学差异(P0.05)。结论在改良超长方案中,通过监测降调节后的血清E_2水平,选择恰当的时机启动Gn,可以在不影响结果的情况下减少Gn的用量,特别对于EMS患者更明显,是一种经济有效的降调节方案。

Effect of starting time of ovarian stimulation on outcomes of in vitro fertilization in women with endometriosis

Objective To investigate the effect of appropriate starting time of gonadotropin (Gn) in modified prolonged protocol on outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) in women with endometriosis (EMS).Methods A total of 98 cycles from infertile patients who underwent IVF/ICSI were retrospectively analyzed.The patients were divided into group A (modified prolonged protocol,EMS,n=44),group B (modified prolonged protocol,non-EMS,n=21) and group C (regular prolonged protocol,EMS,n=33).The difference of clinic outcomes was compared and analyzed among the different groups.Results 1) The total dosage of Gn used was lower and the fertilization rate was higher in group A [(2 330.4 ± 747.8) IU,77.6％]than in group B [(3 338.7 ± 1 341.5) IU,65.8％],the differences were statistically significant (P＜0.05).No statistically significant difference was observed in the number of oocytes retrieved and the clinical pregnancy rate between group A and group B (P＞0.05).2) The initial dosage and total dosage of Gn used in group A [(192.0±35.3) IU,(2 330.4 ± 747.8) IU] was higher than that in group C [(228.8 ± 48.9) IU,(2 828.5 ± 1 129.0) IU],the difference was statistically significant (P＜0.05).The number of retrieved oocytes in group A (8.8 ± 4.7) was higher than that in group C (6.1 ± 3.9),the difference was statistically significant (P＜0.05).No statistically significant difference was found m the fertilization rate,high-quality embryos rate,clinical pregnancy rate between group A and group C (P＞0.05).Conclusion It is a cost-effective controlled ovarian hyperstimulation (COH)protocol for infertile patients with EMS,because the modified prolonged protocol can reduce the dosage of Gn used without affecting the clinical results through monitoring E2 level.