高龄患者IVF-ET周期不同促排卵方案的临床结局分析

目的探讨高龄妇女IVF-ET助孕治疗中5种促排卵方案(长方案、短方案、拮抗剂方案、克罗米芬方案及自然周期方案)的临床效果。方法回顾性分析上海集爱遗传与不育诊疗中心2014~2015年收治的年龄≥35岁患者采用5种不同方案促排卵后行IVF/ICSI-ET助孕的5 031个周期的实验室及临床结局。将患者根据不同的年龄分为3组:35~39岁、40~42岁、42岁,分析不同年龄组不同促排卵方案的Gn用量、天数、获卵数、MⅡ卵数、有效胚胎数、正常受精率、有效胚胎率、周期取消率、新鲜移植及冻融移植临床妊娠率、早期流产率等指标。结果 (1)各不同年龄组的促排卵方案中,患者的基本情况除了自然周期组的基础FSH和抗苗勒管激素(AMH)水平显著低于其他组外(P0.05),其余均无统计学差异(P0.05);(2)各年龄组均表现为:长方案组的Gn天数最长、克罗米芬方案组的Gn用量最少、自然周期组的周期取消率最高,与同年龄组的其他方案组比较均有统计学差异(P0.05);(3)临床妊娠率在35~39岁组的短方案组及自然周期组冻融周期较低(分别为33.70%和27.45%),在40~42岁组的拮抗剂方案组及自然周期组冻融周期妊娠率较低(分别为18.95%和13.33%),与同年龄组的其他方案组比较均有统计学差异(P0.05),而42岁组各促排卵方案间临床妊娠率比较无统计学差异(P0.05);(4)早期流产率在各年龄组的不同促排卵方案间均无统计学差异(P0.05)。结论克罗米芬方案在临床妊娠率及早期流产率与长方案相当的前提下,Gn用量及天数较少,不失为高龄患者较推荐的一种促排卵方案。

Analysis of clinical outcome of different ovarian hyperstimulation protocols in advanced patients undergoing IVF-ET

Objective: To investigate the clinical outcome of five different controlled ovarian hyperstimulation (COH) protocols including long,short,antagonist,clomiphene (CC) protocols and natural cycle for the women with advanced age undergoing IVF-ET.Methods: The laboratory and clinical outcomes data of 5 031 cycles including women aged ≥35 years undergone IVF-ET or ICSI with five different COH protocols in our center from 2014 to 2015 were retrospectively analyzed. The patients were divided into three groups according to different ages: 35-39 years,40-42 years,>42 years. The gonadotropin (Gn) dosage,duration,number of oocytes retrieved,MⅡoocytes,number of available embryos,normal fertilization rate,available embryo rate,cycle cancellation rate,clinical pregnant rate in fresh and frozen cycle,early miscarriage rate were compared among the groups.Results: There was no significant difference in the basic condition in the patients of different age with various kinds of COH protocol (P>0.05),expect that the basal FSH and anti-Mullerian hormone (AMH) levels in the natural cycle group was significantly lower than those in the other groups (P<0.05). Among the three different age group,Gn duration was the longest in long protocol group,and Gn dosage was the least in CC protocol (P<0.05). Meanwhile,the cycle cancellation rate in natural cycle was significantly higher than that in other groups (P<0.05). The clinical pregnant rate in short protocol and natural cycle (33.70% and 27.45%) was significantly lower than the other groups in 35-39 years group (P<0.05). The clinical pregnant rate in antagonist protocol and the natural cycle (18.95% and 13.33%) was significantly lower than that of the other groups in 40-42 years group (P<0.05). In the more than 42 years group,there was no significant difference in clinical pregnant rate among five protocols (P>0.05). There was no difference in early abortion rate among the different groups (P>0.05). Conclusions: Clomiphene protocol is worth to recommend for the advanced patients due to its lower dosage and less duration of Gn,and similar clinical pregnancy rate and early abortion rate as long protocol.