上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

黄体期雌激素预处理对卵巢低反应患者拮抗剂方案体外受精－胚胎移植治疗结局的影响

陆湘，奚吉，姜姗，孙莺，吴正沐，程蔚蔚   

  1. 上海交通大学 医学院附属国际和平妇幼保健院生殖医学科， 上海 200030
  • 出版日期:2016-02-28 发布日期:2016-03-29
  • 通讯作者: 程蔚蔚, 电子信箱: 18017316001@163.com。
  • 作者简介:陆湘（1975—）， 女， 副主任医师， 硕士; 电子信箱: luxiang75@aliyun.com。

Effects of estradiol pretreatment at luteal phase on outcome of in vitro fertilization and embryo transfer treatment of antagonist protocol for patients with poor ovarian responder

LU Xiang, XI Ji, JIANG Shan, SUN Ying, WU Zheng-mu, CHENG Wei-wei   

  1. Department of Reproductive Medicine，International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2016-02-28 Published:2016-03-29

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摘要：

目的 探讨黄体期雌激素预处理对卵巢低反应患者拮抗剂方案体外受精－胚胎移植（IVF-ET）治疗结局的影响。方法 回顾性分析173例接受IVF-ET治疗的卵巢低反应患者，按超促排卵前是否行雌激素预处理（黄体期戊酸雌二醇4 mg/d口服至月经第2日）分为预处理组（n＝96）和未处理组（n＝77），比较两组一般情况及IVF-ET治疗结局相关指标。 结果 两组患者的年龄（P=0.857）、体质量指数（BMI）（P=0.727）、血基础促卵泡激素（FSH）（P=0.926）/促黄体生成素（LH）（P=0.579）/雌二醇（E2）值（P=0.898）、窦卵泡计数（AFC）（P=0.662）、移植日子宫内膜厚度（P=0.542）和移植胚胎数（P=0.321）比较，差异均无统计学意义。与未处理组比较，预处理组超促排卵治疗前血FSH（P=0.000）和LH（P=0.019）水平显著降低，窦卵泡平均直径显著减小（P=0.000），治疗中促性腺激素治疗总量（P=0.001）和使用天数（P=0.001）明显增加，绒毛膜促性腺激素（HCG）日E2（P=0.000）和LH（P=0.000）水平升高；预处理组的获卵数（P=0.001）和可用胚胎数（P=0.005）高于未处理组，但两组间的受精率（P=0.648）、优质胚胎率（P=0.172）、种植率（P=0.845）、临床妊娠率（P=0.948）和继续妊娠率（P=0.899）比较,差异无统计学意义。结论 黄体期雌激素预处理可增加IVF-ET治疗中卵巢低反应患者拮抗剂方案的获卵数和可用胚胎数。

关键词: 雌激素预处理, 卵巢低反应, 促性腺激素释放激素拮抗剂, 体外受精－胚胎移植

Abstract:

Objective To explore the effects of estradiol pretreatment at the luteal phase on the outcome of in vitro fertilization and embryo transfer (IVF-ET) treatment of antagonist protocol for patients with poor ovarian responder. Methods Data of 173 patients with poor ovarian response who have underwent IVF-ET treatment were retrospectively analyzed. Patients were divided into the pretreatment group (n=96) and non-pretreatment group (n=77) according to whether the estradiol pretreatment (oral administration with 17 β-estradiol for 4 mg/d at the luteal phase till the second day of menstrual cycle) were conducted before super ovulation induction. General information and indexes relevant to the outcome of IVF-ET treatment of two groups were compared. Results The differences of age (P=0.857), BMI (P=0.727), basal serum FSH (P=0.926)/LH (P=0.579)/E2 value (P=0.898), basal antral follicle count (AFC) (P=0.662), endometrial thickness (P=0.542) and the number of embryos transferred (P=0.321) on transfer day between the two groups were not statistically significant. Compared with the non-pretreatment group, blood FSH (P=0.000) and LH (P=0.019) levels of the pretreatment group before super ovulation induction significantly decreased, mean antral follicle sizes significantly decreased (P=0.000), the total amount of gonadotropin (P=0.001) and stimulation period (P=0.001) significantly increased, and HCG daily E2 (P=0.000) and LH level (P=0.000) increased. The number of retrieved oocytes (P=0.001) and obtained embryos (P=0.005) of the pretreatment group was larger than that of the non-pretreatment group, while the differences of fertilization rate (P=0.648), high-quality embryo rate (P=0.172), implantation rate (P=0.845), clinical pregnancy rate (P=0.948), and continued pregnancy rate (P=0.899) between two groups were not statistically significant. Conclusion Estradiol pretreatment at the luteal phase can increase the number of retrieved oocytes and obtained embryos during the IVF-ET treatment of antagonist protocol for patients with poor ovarian responder.

Key words: estradiol pretreatment, poor ovarian responder, GnRH antagonist, in vitro fertilization