拮抗剂方案与微刺激方案对卵巢低反应患者体外受精-胚胎移植结局的比较

目的：比较促性腺激素释放激素（GnRH）拮抗剂方案与氯米芬（CC）微刺激方案对卵巢低反应（POR）患者行体外受精-胚胎移植（IVF-ET）的临床结局。方法：回顾性分析2015年1月—2017年12月在上海交通大学附属第一人民医院生殖医学科行体外受精/胞浆内单精子注射（IVF/ICSI）助孕的432个周期POR患者的临床资料。根据促排卵方案不同，分为GnRH拮抗剂组（248个周期）和CC微刺激组（184个周期），比较2组的基本资料及临床结局。结果：2组患者的年龄、基础卵泡刺激素（FSH）、体质量指数（BMI）以及不孕时间差异无统计学意义（P＞0.05）。与CC微刺激组比较，GnRH拮抗剂组的促性腺激素（Gn）使用时间和Gn用量明显增多，内膜厚度、获卵数、有效胚胎数和鲜胚移植率增高，周期取消率明显降低，差异均有统计学意义（P＜0.05）。2组hCG日雌二醇、移植胚胎数、移植优胚数、种植率、妊娠率、继续妊娠率、活产率等差异均无统计学意义（P＞0.05）。结论：对于POR患者采用拮抗剂方案可增加获卵数、有效胚胎数和鲜胚移植率，同时降低周期取消率，可作为POR患者治疗的选择方案之一。

Comparison of In Vitro Fertilization-Embryo Transfer Outcomes between GnRH Antagonist Protocol and Mild Stimulation Protocol in Poor Ovarian Responders

Objective：To compare the effects of gonadotropin-releasing hormone (GnRH) antagonist protocol and clomiphene citrate (CC) mild stimulation protocol on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in patients with poor ovarian response (POR). Methods：The clinical data of 432 IVF/ICSI cycles of POR patients from January 2015 to December 2017 in our department were retrospectively analyzed. According to the ovarian stimulation protocol, those cycles were divided into the GnRH antagonist group (n=248 cycles) and the CC mild stimulation group (n=184 cycles). Results：There were no significant differences in age, basic FSH, BMI and duration of infertility between the two groups (P＞0.05). Compared with the CC mild stimulation group, the GnRH antagonist group had the increased values of the Gn duration, Gn dosage, endometrium thickness, number of oocytes retrieved, number of transferable embrys, and fresh embryo transfer rate (P＜0.05), and the decreased cycle cancellation rate (P＜0.05). There were no significant differences in the estradiol level on trigger day, the number of embryos transferred, the number of high-quality embryos transferred, embryo implantation rate, pregnancy rate, ongoing pregnancy rate and live birth rate between the two groups (P＞0.05). Conclusions：GnRH antagonist protocol can increase the numbers of oocytes and transferable embrys and the rate of fresh embryo transfer, and reduce the cycle cancellation rate in POR patients receiving IVF-ET. It can be used as one of the treatment options for POR patients.