三种不同促排卵方案在卵巢低反应患者中的应用

【目的】比较三种不同的控制性超排卵方案（COH）对卵巢低反应患者的体外受精胚胎移植（IVF—ET）临床结局，旨在寻求更为适合的促排卵方案。A-法】回顾性分析2010年1～12月在本院接受体外受精（IVF）或卵细胞浆单精子注射（ICSI）助孕的卵巢低反应患者133例，超短方案组（A组）36例，改良超长方案组（B组）34例，拮抗剂方案组（C组）63例，比较三组超排卵天数、血清激素水平、获卵数、成熟卵子数、正常受精胚胎数（2PN）、周期妊娠率和胚胎种植率等。【结果】三组治疗后超排卵天数、成熟卵子数、2PN胚胎数、移植胚胎数比较差异均无显著性（P〉0．05）；平均促性腺激素释放激素（GnRH）用量A、B组间差异无显著性（P〉0．05），A、B显著高于C组（P〈0．05）；胚胎种植率A、C组比较无显著性差异（P〉0．05），但均显著低于B组（P〈0．05）；临床妊娠率B组最高，c组次之，A组最低，三组比较有显著性差异（P〈0．05）。【结论】促性腺激素释放激素拮抗剂（GnRH拮抗剂）方案和改良超长方案治疗卵巢低反应是一种有效的超排卵方案，可有效的提高IVF-ET的临床妊娠率。

Application of Three Different Controlled Ovarian Hyperstimulation in Poor Ovarian Responders

Objective]To compare the clinical outcomes of in vitro fertilization-embryo transfer（IVF-ET） with three different controlled ovarian hyperstimulation（COH） in poor ovarian responders in order to find the best suitable COH protocol. Methods]Totally 133 poor ovarian responders receiving in-vitro fertilization（IVF） or intracytoplasmic sperm injection（ICSI） for the assisted reproduction in our hospital from Jan. 2010 to Dec. 2010 were analyzed retro- spectively. Group A（ n = 36） underwent IVF with super-short protocol. Group B（ n = 33） underwent IVF with modified super-long down-regulation protocol. Group C（ n = 63） underwent IVF with gonadotrophin-releasing hor- mone（GnRH） antagonist protocol. The days of COH,： serum levels of hormones, the number of mature ovum, the number of fertilized embryos and pregnancy rate were compared among three groups. Results]The differences of the days of COH, the number of mature ovum and the number of fertilized embryo were not significant among three groups after treatment（ P 〉0. 05）. The dose of gonadotropin（Gn） in group A and B were significantly higher than that in group C（ P 〈0.05）, but there was no significant difference between group A and group B（ P 〉0.05）. The implantation rate in group A and group C were significantly lower than that in group B（ P 〈0.05）, but there was no significant difference between group A and group C（p〉0.05）. The pregnancy rate of Group B was the highest, and that of group A was the second, and group A had the lowest pregnancy rate. There was significant difference in the pregnancy rate among three groups（ P 〈0. 05）. Conclusion]Both GnRH antagonist protocol and modified super-long down-regulation protocol for the treatment of poor ovarian response are effective COH protocol, and can effectively improve the pregnancy rate of IVF-ET.