3种不同超促排卵方案在高龄患者体外受精-胚胎移植中的临床效果分析

目的:探讨高龄(36~45岁)患者采用不同超促排卵方案对体外受精-胚胎移植周期妊娠结局的影响。方法:回顾分析484个周期的高龄患者的资料,根据促排卵方案不同将患者分组:GnRH-a长方案组(148个周期)、拮抗剂方案组(165个周期)、GnRHa超短方案组(171个周期),比较3组患者的基本资料及临床结局。结果:GnRH-a长方案组的h CG日LH水平低于拮抗剂方案组和GnRH-a超短方案组,GnRH-a长方案组的Gn时间最长,获卵数、2PN受精数、2PN卵裂数、优质胚胎数及冷冻数最多(P0.05);GnRH-a超短方案组的Gn用量最多,2PN受精数、2PN卵裂数最少(P0.05)。3组的h CG日子宫内膜厚度、新鲜周期胚胎移植数、周期取消率、早期流产率、活产率比较,差异均无统计学意义(P0.05);胚胎种植率及临床妊娠率:GnRH-a长方案组最高,GnRH-a超短方案组最低,两组比较差异有统计学意义(P0.05)。结论:对于卵巢储备功能相对较好的高龄患者,GnRH-a长方案具有较好的临床结局;对于卵巢储备较差者,拮抗剂方案Gn用量相对少,临床结局尚可,是一种可选择的比较经济的方案。

Clinical efficacy of three controlled ovarian hyperstimulation protocols in advanced age undergoing in vitro fertilization and embryo transfer

Objective:To assess the efficacy of different controlled ovarian hyperstimu-lation protocols in advanced age (36~45 years) on pregnancy outcome undergoing in vitro fer-tilization and embryo transfer. Methods:A retrospective analysis was performed in a total of 484 cycles,which were divided into three groups with different stimulation protocols:GnRH-a long protocol group( Group A,148 cycles);GnRH-ant protocol group ( Group B,165cycles);ultra-short GnRH-a protocol ( Group C,171 cycles). The general conditions and the clinical out-comes of the three groups were compared. Results:The level LH on hCG injection day in group A was significantly lower than that in group B and group C. Group A had the longest duration of gonadotrophin administration,obtained the most number of eggs,2PN fertilization,2PN cleav-age,high-quality embryos and frozen embryos (P<0. 05). Group C had the most total dose of Gn,the least number of 2PN fertilization,2PN cleavage (P<0. 05). There were no statistical differences between the three groups in endometrial thickness,number of embryos transferred, cycle cancelled rate,early abortion rate and live birth rate (P>0. 05). Embryo implantation rate and clinical pregnancy rate in group A was the highest, the second in group B, the lowest ingroup C,while there was significant difference between group A and group C. Conclusion:Gn-RH-a long protocol has a better clinical outcome for advanced age with relatively better ovarian reserve function;for advanced age with poor ovarian reserve,GnRH-ant protocol has an accepta-ble clinical outcome and may be a valid alternative and comparative economic strategy,while re-quiring relatively less Gn dosage.