体外受精-胚胎移植中卵巢低反应患者应用不同超促排卵方案的比较

目的 探讨体外受精-胚胎移植（IVF-ET）中卵巢低反应患者合适的超促排卵方案. 方法 对山东中医药大学第二附属医院生殖医学中心2009年1月至2010年12月120例158个周期采用不同超促排卵方案的卵巢低反应患者的临床资料进行回顾性分析.根据不同的超促排卵方案患者分组：促性腺激素释放激素激动剂（GnRH-a）超短方案组（A组）、克罗米芬微刺激方案组（B组）和自然周期方案组（C组）,对各组临床用药及临床结局进行比较. 结果 三组患者中A组促性腺激素（Gn）用量及用药时间明显多于B组及C组,差异有统计学意义（P＜0.05）,C组在治疗过程中没有应用Gn,与B组比较也有统计学意义（P＜0.05）.注射人绒毛膜促性腺激素（hCG）日内膜厚度、获卵数及临床妊娠率B组低于A组及C组,差异有统计学意义（P＜0.05）,A组及C组间无显著性差异（P＞0.05）.hCG日雌二醇（E2）A组及B组间比较无显著性差异（P＞0.05）,与C组间差异有统计学意义（P＜0.05）.周期取消率A组低于B组及C组,差异有统计学意义（P＜0.05）,B组及C组间比较无显著性差异（P＞0.05）.各组间MⅡ卵率、受精率、卵裂率、优质胚胎率均无显著性差异（P＞0.05）. 结论 对于卵巢低反应的患者,GnRH-a超短方案、克罗米芬微刺激方案及自然周期方案各有利弊,但都是可行的方案,治疗时需要根据患者的不同情况进行个体化的选择.

Comparison of different protocols of controlled ovarian hyperstimulation for the poor responders in cycles of in vitro fertilization-embryo transfer

Objective： To poor responders. investigate the effects of different methods of controlled ovarian hyperstimulation on the Methods： A total of 120 into three groups according releasing hormone agonist（G patients with poor response were treated for 158 cycles,which were divided to different methods of controlled ovarian hyperstimulation： gonadotropin- nRH-a） short protocol（group A）, mininal stimulation（group B）and natural cycle（group C）. The changes of related indexes were evaluated. Results. The dose and duration of gonadotrophin（Gn） adminstration were the highest in group A,and were the lowest in group C（P〈0. 05）. The peak serum E2 level,the mean amount of retried ooeytes and clinical pregnancy rate showed no statistical significance in group A and B（P〉0.05）, hut lower in group C （P〈0.05）. The endometrium was thicker in group A and C than in group B（P〈0.05）. The cycle cancellation rate was higher in group B and C（P〈0.05）than in group A. The M II oocyte rate,the mean fertilization rate,the high-quality embryo rate were not significantly different among the there groups after treatment（P〉0.05）. Conclusions： Individualized protocol of controlled ovarian hyperstimulation should be applied for thepoor responders.