高孕激素状态促排卵与长方案用于不同年龄组供精体外受精的结局

目的比较高孕激素状态下促排卵(PPOS)方案与GnRH-a长方案用于不同年龄组供精IVF的临床结局。方法回顾性分析2015年1月至2016年11月在我院生殖中心接受治疗的供精IVF 385个周期,精子全部来源于精子库。患者按年龄分为35岁和≥35岁两组,并根据促排卵方案分为PPOS方案组和长方案组,比较各组间Gn总量、Gn天数、获卵数、实验室指标及冻融胚胎移植(FET)临床结局。结果 (1)不同年龄组的两种促排卵方案间患者年龄、不孕年限、体重指数(BMI)、基础FSH、LH、E2和基础窦卵泡数(AFC)均无统计学差异(P0.05);(2)年龄35岁组:PPOS方案组Gn总量、Gn天数、获卵数均显著低于长方案组(P0.05),但两种促排卵方案的2PN受精率、2PN卵裂率、可移植胚胎率、优质胚胎率、胚胎利用率和OHSS发生率均无统计学差异(P0.05);(3)年龄≥35岁组:PPOS方案组Gn总量、Gn天数、获卵数和1PN受精率均显著低于长方案组(P0.05),而2PN受精率(80.00%vs.67.54%)、可移植胚胎率(50.00%vs.36.23%)、优质胚胎率(40.74%vs.25.66%)和胚胎利用率(79.63%vs.65.92%)均显著优于长方案组(P0.05);(4)PPOS方案组FET临床妊娠率与长方案组无统计学差异(52.78%vs.47.73%,P0.05)。结论 PPOS方案会显著增加高龄患者受精率和优胚率,与长方案相比,更适于高龄患者促排卵。

Comparison of outcome between progestin-primed ovarian stimulation protocol and long down-regulation protocol in different age groups of IVF with donor sperm

Objective:To compare the clinical outcome between progestin-primed ovarian stimulation (PPOS) protocol and GnRH-agonist (GnRH-a) long protocol in different age group in IVF with donor semen (D-IVF) cycle.Methods:A retrospective analysis was performed in a total of 385 D-IVF cycles in our reproductive center from January 2015 to November 2016,and all of the sperms were from the sperm bank.The patients were divided into two groups according to the age:<35 years group and ≥35 years group,and the patients were subdivided into PPOS protocol group and GnRH-a long down-regulation protocol group (GnRH-a group).The total amount of gonadotropin (Gn),duration of used Gn,the number of oocytes retrieved,laboratory indexes,the clinical outcome of frozen embryo transfer (FET) and complications were compared among the groups.Results:(1) There were no significant differences between the two protocols in age,infertility years,BMI,basal levels of FSH,LH,E2 and number of follicular follicles (AFC)(P>0.05).(2) In the group less than 35 years group,the total amount of Gn,the days of Gn used and the number of oocytes retrieved in PPOS group were significantly lower than those in GnRH-a group (P<0.05).There were no significant differences in the 2PN rate,cleavage rate of 2PN embryos,transplantable embryo rate,good-quality embryo rate,embryo utilization rate and incidence of ovarian hyper stimulation syndrome(OHSS) (P>0.05).(3) In the≥35 years group,the total amount of Gn,days of Gn used,number of oocytes retrieved and 1PN fertilization rate in PPOS group were significantly lower than those of GnRH-a group.However,the of 2PN rate (80.00% vs.67.54%),transplantable embryo rate (50.00% vs.36.23%),good-quality embryos rate (40.74% vs.25.66%),and embryo utilization rate (79.63% vs.65.92%) in PPOS group were significantly higher than those of GnRH-a group (all P<0.05),while no differences were found in clinical pregnancy rate of FET between the two protocols (52.78% vs.47.73%,P>0.05).Conclusions:PPOS protocol significantly increases the fertility rate and good-quality embryo rate in elderly patients.It is more suitable for elderly patients for ovulation induction compared with the GnRH-a long protocol.