不同促排卵方案对子宫内膜异位症妊娠结局的影响因素分析

目的:了解不同促排卵方案对行体外受精-胚胎移植( IVF-ET)子宫内膜异位症(EMT)患者妊娠结局的影响.方法:回顾性分析安徽医科大学第一附属医院生殖医学中心2008年1月至2010年3月因EMT行IVF-ET共262周期的临床资料,根据超促排卵方案不同分为超长方案组、短方案组和长方案组,比较3组间年龄、不孕类型、不孕年限、降调前CA125值、基础FSH、LH、E2水平、基础窦卵泡数、Gn启动量、Gn天数、Gn总量、取卵日E2、P、LH水平、子宫内膜厚度、获卵率、优质胚胎率和临床妊娠率,以及超长方案组降调后血清CA125水平与临床妊娠率的关系.结果:①短方案组年龄大于超长方案组和长方案组(P＜0.05),而3组患者不孕类型和不孕年限比较,差异无统计学意义(P＞0.05)；②短方案组基础FSH水平、Gn启动量、取卵日LH值均较超长方案组及长方案组高(P＜0.05)；短方案组基础窦卵泡数、Gn天数、Gn用量、取卵日子宫内膜厚度及获卵数均少于其他两组(P＜0.05)；超长方案组降调前CA125值大于短方案组及长方案组(P＜0.05).③超长方案组降调后CA125值≤10 KU/L的妊娠率(40.91％)与10～20 KU/L和＞20 KU/L水平的妊娠率(18.31％和17.65％)比较,差异有统计学意义(P＜0.05).结论:对于轻度EMT患者早期发现、早期选择辅助生殖技术治疗可以有效增加临床妊娠率,中重度患者采用超长方案同时检测血清CA125水平,对判断妊娠结局有辅助指导意义.

Influencing Factor Analysis of Different Ovarian Stimulation Programs on the Outcome of Assisted Reproductive Technology in Patients with Endometriosis

Objective:To investigate the impact of different varian stimulation programs on the pregnancy outcome of assisted reproductive technology in patients with endometriosis.Methods:262 cycles of in vitro fertilization-embryo transfer(IVF-ET) outcomes in patients with endometriosis treated in First Affiliated Hospital of Anhui Medical University Reproductive Medicine Center from January 2008 to March 2010 were retrospectively analyzed.According to different controlled ovarian hyperstimulation(COH)programs,the cycles were divided into three groups,A group for the super prolonged therapy group,B group for the short-therapy group,C group for the prolonged therapy group.Patient age,infertility type,infertility duration,serum CA125 before down regulation,basic FSH,LH,E2 levels,basic sinus follicle numbers,Gn start dosage,Gn duration,Gn total dosage,E2,P,LH levels at retrieval day,endometrial thickness,retrieved numbers of oocyte,embryo quality,clinical pregnancy rate,and the relationship of serum CA125 after down regulation in group A and the clinical pregnancy rate,were all compared among the three groups.Results:①The mean age of group B was older than that of group A and group C(P<0.05),but the infertility type and duration were not statistically different among the three groups(P>0.05).②The basic level of FSH,Gn start dosage,LH level on retrieval day for group B were higher than those for group A and C(P<0.05).The basic sinus follicle number,Gn duration,Gn total dosage,endometrial thickness on retrieval day and the number of retrieved oocyte for group B were less than those for group A and C(P<0.05).The CA125 level before down regulation in group A was greater than that in group B and C(P<0.05).③ The pregnancy rate when CA125 ≤ 10 KU/L(40.91%)after down regulation in group A was quite different from that when CA125 at 10~20 KU/L or > 20 KU/L(18.31% and 17.65%)(P<0.05).Conclusions:For mild endometriosis,early diagnosis and choice of assisted reproductive technology can effectively increase the clinical pregnancy rate.For moderate and severe endometriosis,when choosing super prolonged therapy program,checking serum CA125 can assist the judgement of pregnancy rate.