拮抗剂方案与其他方案在卵巢低反应患者中的临床疗效比较

目的 比较拮抗剂方案与短方案、微刺激方案在卵巢低反应患者体外受精-胚胎移植治疗中的临床疗效.方法 对南京医科大学附属南京妇幼保健院生殖中心2014年1月至2015年9月接受体外受精-胚胎移植治疗的卵巢低反应患者临床资料进行回顾性分析,比较拮抗剂方案与短方案、微刺激方案的临床疗效.结果 拮抗剂组与短方案组相比临床疗效相当,但平均促性腺激素释放激素激动剂(Gn)时间更短、Gn用量更少(t值分别为8.72、6.98,均P<0.05).拮抗剂组与微刺激方案组相比,Gn时间、Gn用量高于后者(t值分别为2.90、12.80,均P<0.05),HCG日内膜厚度明显高于后者(t=15.94,P<0.05),获卵数、可移植胚胎数、优质胚胎数均高于后者(t值分别为9.94、19.01、7.04,均P<0.05),且临床妊娠率、累计妊娠率均高于后者(χ2值分别为1.82、11.29,均P<0.05),周期取消率低于后者(χ2=11.74,P<0.05),而两组流产率无明显差异(χ2=0.19,P>0.05).结论 对于卵巢低反应患者,拮抗剂方案可以获得相对满意的临床妊娠率,同时具有经济性较高、治疗周期短、周期取消率较低等优点,值得临床推广.

Comparative study of clinical curative effect of GnRH antagonist protocol and other protocols on patients with poor ovarian response

Objective To compare the clinical curative effects of gonadotropin releasing hormone antagonist ( GnRH-ant ) protocol, gonadotropin releasing hormone agonist ( GnRH-a ) short protocol and micro-stimulation protocol on patients with poor ovarian response (POR) in vitro fertilization-embryo transfer ( IVF-ET) treatment.Methods Retrospective analysis was performed on clinical data of patients with POR receiving IVF-ET during the period of January 2014 to September 2015 in Reproductive Medical Center of Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University to compare the clinical curative effect of different protocols.Results GnRH antagonist protocol had similar clinical curative effect to GnRH agonist short protocol, but the Gn time and Gn dose were lower than those of GnRH agonist short protocol (t value was 8.72 and 6.98, respectively, both P<0.05).Compared with micro-stimulation protocol, the Gn time and Gn dose were more (t value was 2.90 and 12.80, respectively, both P <0.05), the endometrial thickness of HCG was significantly higher (t=15.94, P<0.05), and the numbers of egg, portable embryo and high quality embryo were higher in GnRH antagonist protocol (t value was 9.94, 19.01 and 7.04, respectively, all P<0.05).In addition, the clinical pregnancy rate and cumulative pregnancy rate of patients with GnRH antagonist protocol were higher than those with micro-stimulation protocol (χ2 value was 1.82 and 11.29, respectively, both P<0.05), but the cycle cancellation rate was lower (χ2 =11.74, P<0.05).No significant difference was found in abortion rate between two groups (χ2 =0.19, P>0.05).Conclusion For patients with POR, GnRH antagonist protocol can achieve good clinical pregnancy rate with the advantages of high economic effectiveness, short treatment period and low cycle cancellation rate, so it is worth clinical promation.