控制性超排卵治疗中卵巢高反应影响因素分析

目的:筛选影响卵巢反应性的相关因素,用以指导临床制定合理的超排卵方案。方法:回顾性分析183例进行长方案降调下行控制性超排卵治疗者,按获卵数>15枚和4～15枚且使用Gn起步≤3支/d分为高反应组(n=96)和正常反应组(n=87)。结果:与低反应组比,高反应组窦卵泡数较多(P<0.05)、注射hCG日E2水平高(P<0.01)、基础FSH水平较低(P<0.05)。Logistic分析示基础FSH水平为保护因素(B=-0.608,P<0.01),窦卵泡数(B=1.675,P<0.01)、降调后LH水平(B=0.98,P=0.01)为危险因素。使用Gn 2支/d(75 IU/支)和3支/d起步发生高反应的几率分别是1支/d起步的7.4倍和6.7倍,而两者本身无显著差异。治疗结局:高反应组冷冻胚胎率和卵巢过度刺激综合症(OHSS)发生率均高于正常反应组(P<0.05)。结论:对于窦卵泡数多、基础FSH水平低或降调后LH水平较高的患者应尽量采用Gn 1支/d起步。

Analysis of the Ovarian Hyper-Response Related Factors in Controlled Ovarian Hyperstimulation Treatment

Objective：To select the related factors which affect the ovarian response for working out an optimal COH method.Methods： A database was analyzed retrospectively concerning GnRH-agonist long protocol IVF or ICSI COH cycles.Totally183 cycles（Gn using≤225 IU/d） was divided into 2 groups,hyper-response group（96 cycles,No.of oocytes retrived 15） and normal-response group（87 cycles,No.of oocytes retrived 4-15）.Results： Compared with normal-response group,hyper-response group had more AFC,higher E2 level on the day of hCG injection and lower basic FSH level（P0.05）.Logistic regression showed that basic FSH level was a protective factor,AFC and down-regulated LH level were risk factors.The ovarian hyper-response rate of the patients who＇s Gn starting by 150 IU/d or 225 IU/d was 7.4 or 6.7 times as high as the the one starting by 75 IU/d.And there was no diffrence between Gn starting by 150 IU/d and 225 IU/d.Ovarian hyper-response patients can receive more frozen embryos（P0.05）,but the risk of OHSS rate will be increased,too（P0.05）.Conclusion： For the patient with more AFC,lower basic FSH leval or higher down-regulated LH level,the Gn beginning dose should be 75 IU/d to avoid ovarian hyper-response and achieve ideal pregnancy outcome.