卵泡输出率在下丘脑垂体性闭经患者体外受精-胚胎移植中的应用研究

目的探索卵泡输出率(FORT)在接受体外受精-胚胎移植(IVF-ET)治疗的下丘脑垂体性闭经(HH)患者的卵巢反应性及妊娠结局的预测作用。方法收集北京协和医院生殖中心IVF-ET治疗的40例HH患者共60个周期,按FORT值将其分为高(FORT≥100%)、中(100%FORT≥50%)、低(FORT50%)三组,回顾性分析三组间控制性促排卵治疗过程中的临床及实验室数据。结果高、中、低三组窦卵泡数分别为(7.1±2.7)、(9.6±5.3)和(10.7±5.4)个,FORT值越高者窦卵泡数量越少,差异具有统计学意义(P0.05);经外源性促性腺激素治疗后,药物使用剂量及天数在三组间无统计学差异(P0.05);高、中、低三组间HCG日的雌激素(E2)水平分别为(12 918.77±7 472.12)pmol/L、(9 716.33±5 872.00)pmol/L和(6 556.82±3 780.83)pmol/L]、排卵前卵泡数量分别为(8.7±2.6)、(6.9±2.9)和(4.9±2.3)个]、获卵数分别为(9.3±3.8)、(7.8±3.3)和(6.5±3.0)个]、MII卵数分别为(7.8±4.2)、(6.3±3.2)和(5.4±2.5)个]均有统计学差异(P0.05);而优胚数、胚胎种植率、冷冻胚胎数、临床妊娠率等三组间均无统计学差异(P0.05)。结论对于HH患者,FORT可有效地指示IVF-ET过程中的卵泡对Gn的反应性,高FORT值患者将有机会获得更多的成熟卵母细胞,而对妊娠结局的预测作用有待更大样本量的研究证实。

Application of follicular output rate in IVF-ET in patients with hypothalamic-pituitary amenorrhea

Objective:To explore the predictive value of follicular output rate (FORT) in IVF-ET cycle in the patients with hypogonadotropic hypogonadism (HH).Methods:A total of 60 IVF-ET cycles in 40 HH patients were studied.The cycles were divided into three groups according the FORT value:low (<50%),medium (100%>FORT≥50%) and high (≥100%) FORT groups.The clinical and laboratory parameters of controlled ovarian hyperstimulation and IVF-ET in the three groups were retrospectively analyzed.Results:The antral follicle count was increased progressively from low to the high FORT group (7.1±2.7,9.6±5.3 and 10.7±5.4,respectively,P<0.05).The total dosage and days of gonadotropin used were not significantly different among the three groups (P>0.05).However,The serum E2 levels on HCG day (12 918.77±7 472.12,9 716.33±5 872.00,6 556.82±3 780.83 pmol/L,respectively),the number of follicles before ovulation (8.7±2.6,6.9±2.9,4.9±2.3,respectively),the number of oocytes retrieved (9.3±3.8,7.8±3.3,6.5±3.0,respectively) and number of MII oocytes (7.8±4.2,6.3±3.2,5.4±2.5,respectively) were significantly higher in the high FORT group than those in other two groups (all P<0.05).There were no differences in the number of high quality embryo,embryo implantation rate,number of frozen embryos,and clinical pregnancy rate in the three groups.Conclusions:Follicular output rate may be used as a qualitative reflector for reactivity of follicles to gonadotropin in IVF-ET cycle in HH patients.High FORT may have more chance of getting more maturation oocytes.The predictive effect on pregnancy outcome remains to be confirmed by a larger sample size