标准长方案治疗的不孕患者改行改良超长方案后对妊娠结局的影响

目的 探讨不孕症患者因长方案垂体降调不全改行改良超长方案联合人绝经期促性腺激素（HMG）促排卵后进行体外受精/卵胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）对妊娠结局的影响。方法 回顾性分析2015年6月至2016年6月在安徽省立医院生殖中心接受标准长方案IVF或ICSI治疗的不孕患者218例临床资料。根据垂体是否达到降调标准及是否需再次降调,将218例患者分为A组（行标准长方案降调完全的患者）98例,B组（行标准长方案降调不全改行改良超长方案降调的患者）104例,C组（行标准长方案降调不全直接促排卵的患者）16例,统计分析这3组患者行IVF/ICSI-ET的促排卵参数（促排天数、促性腺激素用量、获卵数,受精率、卵裂率、优质胚胎率）及妊娠结局（临床妊娠率、胚胎着床率、流产率、双胎率）。结果 3组患者促排天数、Gn用量、获卵数比较,差异无统计学意义（P>0.05）；A组受精率（77.86%）高于B组（66.98%）,差异有统计学意义（P<0.01）；A组优质胚胎率（68.52%）高于B组（68.52%）,差异有统计学意义（P<0.01）。胚胎着床率、临床妊娠率及周期取消率3组比较,差异无统计学意义（P>0.05）。结论 不孕症患者因垂体降调不全而改行改良超长方案不影响胚胎着床率及临床妊娠率,具有可行性。

Effect of improved super-long protocol on pregnancy outcome after treatment of standard longprotocol in infertility patients

Objective To discuss the pregnancy outcome of in vitro fertilization or intracytoplasmic sperm injection and embryo transplantation (IVF/ICSI-ET) after ovulation induction with human menopausal gonadotropin (HMG)inthose infertility patients who received improved super-long protocols because of incomplete pituitarydownregulation by standard long protocols. Methods The clinical data of218 infertility women, ever received the IVF or ICSI treatment of standard long protocols in our center from Jun 2015 to Jun 2016, were retrospectively analyzed, and all patients were divided into 3 groupsaccordingto whether pituitary downregulation limitation being reachandadditional downregulation being performed. Women in group A (98 cases)received standardlong protocols and complete downregulation, women in group B (104 cases)received improved super-long protocols because of incomplete downregulation by standard long protocols, and women in group C (16 cases)received directovulation inductionbecause ofincomplete downregulation by standard long protocols. The indicators of ovulation inductionafterIVF or ICSI treatment in patients of the 3 groups, such as days of ovarian stimulation, dosage of gonadotropins, number of eggs, rate of fertilization, rate ofcleavage and rate of high-quality embryos,together with their pregnancy outcomes (rate of clinical pregnancy, rate of embryo implantation, rate of spontaneous abortion and rate of gemellary pregnancy),were compared and analyzed.Results Differences in the days of ovulation induction, dosage ofgonadotropinsand number of eggs in patients of the3 groups were notstatistically significant (all P>0.05), but the rates of fertilization and high-quality embryos in group A were significantlyhigher than thosein group B(all P<0.01).There was no significant differenceinthe rates of embryo implantation,clinical pregnancyand cycle cancellation among group A,B and C(all P>0.05).Conclusion Application of improved super-long protocols because of incomplete pituitary downregulation in those infertility women would not affect theirembryo implantation and clinical pregnancy rates, and is feasiblefor clinical practice.