改良超长拮抗剂方案在卵巢高反应性不孕治疗中的应用研究

目的研究改良超长拮抗剂方案(ISIAR)在卵巢高反应性(HOR)不孕患者治疗中的应用效果。方法选择2015年7月至2020年6月于我院治疗HOR不孕患者94例,随机分为ISIAR组(n=47)与对照组(n=47)。对照组给予常规拮抗剂方案,ISIAR组给予ISIAR。观察两组Gn使用情况、获卵数及受精情况,肌注Gn、HCG日血清肿瘤坏死因子(TNF)、血管内皮生长因子(VEGF)及基质金属蛋白酶3(MMP-3)等血清相关因子水平,妊娠结局及中重度OHSS发生情况。结果ISIAR组受精率、优质受精卵率均大于对照组,Gn使用时间、Gn使用量、获卵数、移植受精卵数均小于对照组(P<0.05)。肌肉注射Gn、HCG日,ISIAR组血清TNF水平均高于对照组,血清VEGF、MMP-3水平均低于对照组(P<0.05)。ISIAR组临床妊娠率、正常妊娠率均大于对照组,中重度OHSS率小于对照组(P<0.05)。两组异位妊娠率、早期流产率差异均无统计学意义(P>0.05)。结论ISIAR应用于HOR不孕患者可降低HOR,增加受精率、优质受精卵率,改善血清相关因子水平及妊娠结局,降低中重度卵巢过度刺激综合征发生率。

Application of improved super-long antagonist regimen in the treatment of high ovarian response infertility

Objective To investigate the application of improved super-long antagonist regimen(ISIAR)in the treatment of high ovarian response(HOR)infertility.Methods Ninety patients with HOR infertility in our hospital from July 2015 to June 2020 were randomly divided into ISIAR or control group,47 in each group.The control group was given a conventional antagonist regimen while the ISIAR group was given ISIAR.The gonadotropin(Gn)usage,egg number,serum levels of tumor necrosis factor(TNF),vascular endothelial growth factor(VEGF)and matrix metalloproteinase 3(MMP-3)on the day of intramuscular injection of Gn and HCG,pregnancy outcome and occurrence of moderate to severe OHSS were observed in the two groups.Results The fertilization rate and high quality fertilized egg rate in the ISIAR group were all higher than those in the control group,and Gn use time,Gn usage,number of obtained egg and transplanted fertilized egg were all lower than those in the control group(P<0.05).On the day of intramuscular injection of Gn and HCG,serum TNF levels in the ISIAR group were higher than those in the control group,while serum VEGF and MMP-3 levels were lower than those in the control group(P<0.05).The clinical pregnancy rate and normal pregnancy rate in the ISIAR group were higher than those of the control group,and the rate of moderate to severe OHSS was lower than that of the control group(P<0.05).There was no difference in ectopic pregnancy rate and early abortion rate between the two groups(P<0.05).Conclusion ISIAR application in HOR infertility patients can reduce the HOR,increase the fertilization rate and high quality fertilized egg rate,improve the serum related factors and pregnancy outcome,and reduce the incidence of moderate to severe OHSS.