不同超促排卵方案对高龄患者体外受精结局影响的研究

目的:探讨两种不同超促排卵方案对接受体外受精胚胎移植(IVF-ET)手术的高龄不孕患者卵泡液中IL-15、IL-18、IL-12/IL-23亚基p40水平及妊娠结局的影响,以及高龄患者最佳的超促排卵方案。方法:选择2008年4月～2008年12月在我院行IVF-ET手术的40例年龄35～43岁的不孕妇女为研究对象,随机分为两组,A组用促性腺激素激动剂+促性腺激素(GnRH-a+Gn)短方案,B组用促性腺激素拮抗剂+促性腺激素(GnRH-ant+Gn)的超促排卵(COH)方案,测定两组患者HCG注射日、取卵日、胚胎移植日外周血甾体激素水平及取卵日卵泡液IL-15和IL-12/IL-23亚单位p40的浓度,比较两组患者的周期结局。结果:B组患者的HCG注射日血清E2值和卵泡液IL-15含量低于A组,移植日P水平高于A组,差异有统计学意义(P0.05);A组Gn用药天数、剂量、移植日E2水平高于B组,但差异无统计学意义(P0.05);两组卵泡液E2和P水平、获卵数、受精率、优质胚胎率、流产率和卵泡液细胞因子IL-18、IL-12/IL-23亚基p40含量无统计学差异(P0.05)。B组临床妊娠率高于A组(45%vs 35%),但差异无统计学意义(P0.05)。结论:接受IVF-ET手术的高龄不孕患者,临床选择促性腺激素拮抗剂+促性腺激素的超促排卵方案可获得较好的妊娠结局。

The observation of effect of two different COH protocols on the IVF-ET outcome of aged patients

Objective:To explore the influence of two different COH protocols on ova-rian follicular concentration of IL-12,IL-15,IL-18 and p40 subunit of IL-12 and 23 and IVF-ET outcome,and the better COH protocols for aged infertility.Methods:Forty infertility patients who were 35～45 years old and received in-vitro-fertilization and embryo transfer(IVF-ET) from Apr.2008 to Dec.2008 were randomly divided into two groups,the patients in group A accepted the GnRH-a+Gn protocol,while the patients in group B accepted the GnRH-ant+Gn protocol.The concentration of blood serum hormone levels on hCG injecting day,eggs day,embryo transfer day,and ovarian follicular concentration of IL-12,IL-15,IL-18 and p40 subunit of IL-12 and 23 were determined,the days and dose of Gn,the amount of eggs,the number of the high quality embryo were measured,the clinic pregnancy rate and miscarriage rate between A,B groups were compared.Results:The level of serum estrogen(E2) on the HCG injecting day and ovarian follicular concentration of IL-15 of group B patients were less than that of group A,P levels on the embryo transfer day was higher than that of group A(P<0.05).The number of days,dosage of Gn and the level of E2 on the embryo transfer day of group A were higher than that in group B,but there was no statistical significance(P>0.05).There were no significant difference in the level of E2,P in the ovarian follicular,the number of eggs,the fertility rate,the high-quality embryos rate,abortion rates and follicular fluid cytokine IL-18,IL-12/IL-23 subunit p40 concentration between the two groups(P>0.05).The clinical pregnancy rate of group B was higher than that of group A(45% vs 35%),but there was no statistical significance(P>0.05).Conclusion:For aged infertility,the GnRH-ant protocol is excelled which can have better IVF-ET outcome.