卵泡发育不均时优势卵泡排出后继续黄体期促排的可行性

目的： 探讨不孕患者在体外受精常规促排卵过程中卵泡发育不均时，予优势卵泡排出后继续黄体期促排卵的可行性。 方法： 回顾性分析2012 年5月至2014 年2月期间温州医科大学附属第一医院生殖医学中心35例不孕患者，在体外受精常规促排卵方案过程中，B超监测卵泡发育不均出现优势卵泡后，至少有一个卵泡排卵后且测定血中孕酮升高大于8 nmol/L，继续予促性腺激素促排卵直至卵泡成熟，分析其获卵数及优质胚胎数等，本周期进行全胚冷冻，于下一周期根据患者排卵情况采用自然周期或替代周期进行内膜准备，然后进行冻融胚胎移植（FET），分析其种植率、流产率和临床妊娠率。 结果： 35例患者中除1例患者未获卵，34例总获卵数为412个，平均获卵数为（12.12±11.09）个。受精率为75.40%，卵裂率为71.12%，共获得优质胚胎数167个，冷冻胚胎数为158个，除外1例因胚胎解冻质量差而放弃移植，共完成第一次FET为33个周期，继续第二次FET 3个周期，移植冻融胚胎数共74个，平均移植胚胎数（2.06±0.67）个，种植率为37.83%，hCG阳性率为63.89%。19例临床妊娠，累计临床妊娠率为52.78%。有1例患者孕2个月时流产，流产率为5.26%，已分娩10例，产下13个健康活婴，活产率为30.30%，余8例继续妊娠中。结论： 体外受精常规促排过程中卵泡发育不均时，予优势卵泡排出后继续黄体期促排卵可获得理想的获卵数和优质胚胎数，而且后续冻融胚胎移植周期的累计临床妊娠率高，是一种安全可行值得期待的挽救方案。

The feasibility analysis of luteal-phase ovarian stimulation after the dominant follicle ovulated in unsynchronized multiple folliclar development patients

Objective: To explore the feasibility of luteal-phase ovarian stimulation after the dominant follicle ovulated in unsynchronized multiple folliclar development patients undergoing routine controlled ovarian hyperstimulation (CoH). Methods: From May 2012 to February 2014, 35 infertile patients undergoing in-vitro fertilization (IVF) in Reproductive Medicine Center, the First Affiliated Hospital of Wenzhou Medical University were enrolled in the study. When there comes unsynchronized multiple folliclar development during the routine CoH, continue using gn until the follcle matured after the dominant follicle ovulated and serum progesterone exceeded 8 nmol/L. The highest quality embryos were extracted and cryopreserved for the next frozen embryo transfer (FET) cycles. Analyze the number of oocytes retrieved, implantation rate, clinical pregnancy rate, ongoing pregnancy rate. Results: all patients succeeded in producing oocytes except one, a total of 412 ocytes were retrieved, the average number of oocytes retrieved was 12.12±11.09, producing 167 highest quality embryos, fertilization rate was 75.40%, cleavage rate was71.12%. A total of 158 ocytes were cryopreserved for later transfer. one patient quitted cycles because of embryos’ thawing failure. A total of 34 women underwent a total of 36 FET cycles, including 33 patients who completee one FET, 3 who finished two FETs, and a total of 74 embryos were transferred.In FETs, the implantation rate and cumulative pregnancy rate were 37.83%, 52.78%, respectively. one woman was reported to have miscarried in the first trimester (5.26%). of the 19 pregnancies in the study, 10 resulted in live births and 8 were ongoing. Delivery follow-up showed 3 twin births and 7 single births,no malformations were reported in the newborns. Conclusion: Luteal-phase ovarian stimulation is feasible for producing competent oocytes/embryos in women undergoing routine controlled ovarian hyperstimulation (CoH)after the dominant follicle ovulated in unsynchronized multiple folliclar development, with optimal pregnancy outcomes in FET cycles. It’s a safety and exciting remedial measure.