黄体期雌二醇预处理方案改善卵巢低反应者体外受精-胚胎移植结局的初步研究

目的探讨促排卵周期前应用口服雌二醇（E2）对体外受精-胚胎移植（in vitro fertilization embryo transfer，IVF-ET）术中卵巢反应不良者的意义。方法对52例在我中心行IVF-ET术的卵巢反应不良患者分为黄体中后期补充E2者25例（试验组）及未补充E2者27例（对照组）；试验组中14例在一年内行两次IVF-ET的患者，进行自身配对前后对照（配对试验组vs配对对照组）。对纳入患者的病历资料进行统计分析，评估口服E2预处理对卵巢低反应患者促排卵的效果以及对IVF-ET结局的影响。结果试验组与对照组促性腺激素（Gn）用量、刺激天数、内膜厚度、成熟卵泡数、获卵数、E2峰值、可移植胚胎数、受精率、临床妊娠率等均无显著差异（P〉0．05），但获卵数、可移植胚胎数、受精率、临床妊娠率有增高趋势。配对试验组较配对对照组有显著增高的获卵数、hCG日E2水平、hCG日直径〉14mm卵泡、可移植胚胎数（P均〈0．05），刺激天数延长（P〈0．05），受精率、临床妊娠率仅有增高趋势，而Gn用量、内膜厚度无显著差异性（P〉0．05）。结论对卵巢反应不良的患者，在IVF-ET术前黄体中后期口服E2可以延缓卵泡生长速度，改善促排卵治疗效果，提高胚胎质量，而不影响内膜厚度。

The research of luteal estradiol pre-treatment for anticipated poor responders to improve outcome of IVF

Objective： To investigate whether the luteal estradiol （E2） administration could enhance ovarian response before the stimulation cycle for IVF-ET cycles in poor responders. Methods： Fifty-two poor responders undergoing IVF-ET cycles were divided into 2 groups randomly： patients in trial group had been administrated with E2 after the ovulatory period （n=25）, while whose in control group were not treated with the drug （n=27）. There were 14 patients who had previously attempted stimulation in the trial group. We compared responses on the luteal E2 pre-treatment protocol（matched trial group） with the previous IVF cycles （matched control group）. A statistical analysis of the stimulation parameters for patients was carried out to assess whether the luteal estradiol （E2） pre-treatment could enhance ovarian response or not. Results： The required doses of gonadotrophin, days hCG administration, number of oocytes retrieved and av of stimulation, endometrial thickness on day of tilable embryos, mean fertilization rate, clinical pregnancy rate were not statistically different between trial group and control group, but there was a trend toward an improved number of oocytes retrieved and available embryos, mean fertilization rate, clinical pregnancy rate. However, the matched trial group had a significantly higher mean E2 levels on day of hCG administration, mean number of oocytes retrieved and available embryos, a significantly longer days of stimulation compared with the matched control group, while there was a trend toward an improved mean fertilization rate and clinical pregnancy rate, but doses of gonadotrophin and endometrial thickness on day of hCG administration were not. Conclusion： Luteal E2 administration before IVF-ET appears to improve ovarian responsiveness during COH for IVF and may result in more uniform follicular development, more oocytes retrieved, more available embryos and has little influence on endometrium.