40岁以上患者体外受精-胚胎移植不同促排方案的疗效分析

目的:探讨在40岁以上高龄患者中最适的IVF-ET促排方案。方法:回顾性比较分析176例年龄≥40岁接受IVF-ET助孕患者的临床结局,根据患者促排方案的不同分为GnRH激动剂长方案组(A组,56个周期)、GnRH激动剂短方案组(B组,103个月周期)和微刺激组(C组,86个周期)。比较3组患者的临床资料及助孕结局。结果:3组患者的平均年龄、基础FSH、不孕年限、妊娠率、流产率、每可利用胚胎所需Gn量等均无统计学差异(P>0.05)。3组患者的Gn使用天数、可利用胚胎数、成熟卵子数、每成熟卵子所需Gn量两两比较结果显示:A组最高,B组次之,C组最低,组间均有统计学差异(P<0.001)。3组患者的周期取消率A组最低,B组次之,C组最高,组间均有统计学差异(P<0.05)。3组患者hCG注射日内膜厚度B、C组间差异无统计学意义,但均低于A组,差异有明显统计学意义(P<0.001)。结论:适当增加Gn用量可以改善高龄患者的助孕结局;长方案和微刺激方案更适合于高龄患者。长方案耗时及花费较高,但可以改善部分高龄患者助孕结局,是一种有效的促排卵方案;而微刺激方案是一种经济的促排卵方案,可以获得相当的累计妊娠率。

Effectiveness of Different Stimulantion Protocols in Patients More than 40 Years Old Undergoing in vitro Fertilization and Embryo Transfer Treatment(IVF-ET)

Objective：To compare the effect of different stimulantion protocol in patients ≥40 years old who underwent in vitro fertilization and embryo transfer（IVF-ET） treatment.Methods：A comparatively retrospective analysis was performed 176 patients≥40 years old who underwent IVF-ET.They were divided into 3 groups based on different stimulantion protocols：GnRH-a long protocol group（group A,56 cycles）;GnRH-a short protocol group（group B,103 cycles）;mini-stimulation protocol group（group C,86 cycles）.General conditions and IVF/ICSI-ET were compared among the 3 groups.Results：There was no significant difference among the 3 groups in duration of infertility,base FSH,female patient age,clinical pregnancy rate,the Gn ampouls per useful embryo,abortion rate（P0.05）.There was a significant difference among the 3 groups of the days of Gn stimulating,the number of MⅡoocyte and useful embryo,the Gn ampouls per MⅡ oocyte,cancelled cycle rate（P0.001）.No significant differences was found in endometrial thickness on the day of hCG administration between group B and group C,but thinner than that in group A（P0.001）.Conclusion：Appropriate increasing the Gn ampouls can improve the outcome of elderly patients.The long protocol and the mini-stimulation protocol are more suitable for elderly patients.The long protocol,time-consuming and costly,may improve the outcome of part elderly patients,it is an effective ovarian stimulation protocol;the mini-stimulation protocol is an economical protocol with approximate cumulative pregnancy rate.