微刺激促排卵方案对卵巢功能正常的不孕患者妊娠结局的效果分析
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摘要
目的探讨微刺激促排卵方案对卵巢功能正常的不孕患者妊娠结局的效果。方法选取冀中能源峰峰集团有限公司总医院和石家庄市妇产医院2015年6月至2017年11月接受辅助生殖助孕治疗且年龄<35岁女性共计207个治疗周期的临床资料进行回顾性分析。按促排卵方案的不同分为微刺激组(91个周期)和长方案组(116个周期)。比较两组患者促性腺激素(gonadotropin,Gn)用药时间和总量、人绒毛膜促性腺激素(human chorionic gonadotropin, hCG)日子宫内膜厚度、hCG日黄体生成素(luteinizing hormone,LH)及雌二醇(estradiol,E_2)水平、获卵数、可用胚胎数、可移植胚胎数、临床妊娠率、卵巢过度刺激综合征(ovarian hyper stimulation syndrome,OHSS)发病率等。结果微刺激组91个周期中,有2例因黄体酮水平升高、E_2下降而取消用药周期,2例患者早发LH峰排卵而未取卵,3例因胚胎质量差而取消移植,微刺激组共有87个周期进行采卵和84个周期进行胚胎移植。长方案组116个促排卵周期中均获卵,发生OHSS而取消3个周期,共113个周期进行胚胎移植。微刺激组和长方案组患者Gn用药时间分别为(6.1±2.0)d、(9.9±2.1)d,Gn用药总量分别为(430.2±197.6)U、(1 987.1±809.7)U,hCG日LH分别为(6.5±3.2)U/L、(1.8±1.1) U/L,hCG日E_2分别为(3 497.8±135.1)pmol/L、(10 986.7±.4) pmol/L,获卵数分别为(7.6±3.1)个、(15.0±6.9)个,可用胚胎数分别为(2.2±1.0)个、(6.4±3.5)个,两组比较差异均有统计学意义(t值分别为6.658、10.327、5.471、11.275、4.702、5.376,均P<0.01)。微刺激组和长方案组患者可移植胚胎数(1.9±0.5)个、(2.3±0.4)个,临床妊娠率分别为40.5%(34/84)、50.4%(57/113),OHSS发病率分别为0(0/91)、2.6%(3/116),两组比较差异均无统计学意义(P>0.05)。结论采用微刺激方案患者可以获得与长方案患者相当的治疗效果,且降低了OHSS的发生率。但也可能出现早发LH峰而造成早发排卵或取消周期。因此,临床中对于卵巢功能正常的患者在施行辅助生殖助孕治疗时应根据患者具体情况实施个体化治疗。
Objective To investigate the effect of micro-stimulation ovulation induction on pregnancy outcome of infertile women with normal ovarian function. Methods 207 cases(﹤35 y) of assisted reproductive therapy in General Hospital of Jizhong Energy Fengfeng Group Co., Ltd. and Shijiazhuang Obstetrics and Gynecology Hospital from June 2015 to November 2017 were divided into micro-stimulation group(91 cases) and long-term regimen group(116 cases) according to the different ovulation induction. The time and total dosage of gonadotropin(Gn), endometrial thickness on the day of hCG, LH and E_2 levels on the day of hCG, number of eggs obtained, number of embryos available, number of transplantable embryos, clinical pregnancy rate and incidence of OHSS were compared between the two groups. Results In the 91 cycles of the micro-stimulation group, 2 cases were cancelled because of the increase of progesterone level and the decrease of E_2, 2 cases were ovulated at the early LH peak, 3 cases were cancelled because of the poor quality of embryos. There were 87 cycles in the micro-stimulation group and 84 cycles for embryo transfer. In the 116 cycles of long-term regimen group, 3 cases were cancelled because of OHSS and 113 cycles for embryo transfer.The duration of Gn administration in micro-stimulation group and long-term regimen group were(6.1±2.0)d and(9.9±2.1)d respectively. The total dosage of Gn in two groups were(430.2±197.6) U and(1 987.1±809.7)U respectively. The daily LH levels of hCG in the micro-stimulation group and long-term regimen group were(6.5±3.2) U/L and(1.8±1.1) U/L respectively. The daily E_2 levels of hCG in two groups were(3 497.8±135.1) pmol/L and(10 986.7±.4) pmol/L respectively. The number of eggs obtained in two groups were(7.6±3.1) and(15.0±6.9) respectively. The number of embryos available in two groups were(2.2±1.0) and(6.4±3.5) respectively. There were significant differences between the two groups(t=6.658,10.327,4.471,11.275,4.702,5.376,P<0.01). The number of transplantable embnyos in the two groups were(1.9±0.5)and(2.3±0.4)respectively. The clinical pregnancy rates in micro-stimulation group and long-term regimen group were 40.5 %(34/84) and 50.4 %(57/113) respectively. The incidence of OHSS in two groups were 0(0/91) and 2.6 %(3/116) respectively. There was no significant difference between the two groups(P>0.05). Conclusion Patients with micro-stimulation ovulation induction can achieve the same therapeutic effect as patients with long-term regimen and reduce the incidence of OHSS. However, there are also some shortcomings such as the early onset of LH peak, which may lead to early ovulation or cancellation of cycle. Therefore, patients with normal ovarian function should be treated individually according to the specific conditions of patients in clinical practice.
Objective To investigate the effect of micro-stimulation ovulation induction on pregnancy outcome of infertile women with normal ovarian function. Methods 207 cases(﹤35 y) of assisted reproductive therapy in General Hospital of Jizhong Energy Fengfeng Group Co., Ltd. and Shijiazhuang Obstetrics and Gynecology Hospital from June 2015 to November 2017 were divided into micro-stimulation group(91 cases) and long-term regimen group(116 cases) according to the different ovulation induction. The time and total dosage of gonadotropin(Gn), endometrial thickness on the day of hCG, LH and E_2 levels on the day of hCG, number of eggs obtained, number of embryos available, number of transplantable embryos, clinical pregnancy rate and incidence of OHSS were compared between the two groups. Results In the 91 cycles of the micro-stimulation group, 2 cases were cancelled because of the increase of progesterone level and the decrease of E_2, 2 cases were ovulated at the early LH peak, 3 cases were cancelled because of the poor quality of embryos. There were 87 cycles in the micro-stimulation group and 84 cycles for embryo transfer. In the 116 cycles of long-term regimen group, 3 cases were cancelled because of OHSS and 113 cycles for embryo transfer.The duration of Gn administration in micro-stimulation group and long-term regimen group were(6.1±2.0)d and(9.9±2.1)d respectively. The total dosage of Gn in two groups were(430.2±197.6) U and(1 987.1±809.7)U respectively. The daily LH levels of hCG in the micro-stimulation group and long-term regimen group were(6.5±3.2) U/L and(1.8±1.1) U/L respectively. The daily E_2 levels of hCG in two groups were(3 497.8±135.1) pmol/L and(10 986.7±.4) pmol/L respectively. The number of eggs obtained in two groups were(7.6±3.1) and(15.0±6.9) respectively. The number of embryos available in two groups were(2.2±1.0) and(6.4±3.5) respectively. There were significant differences between the two groups(t=6.658,10.327,4.471,11.275,4.702,5.376,P<0.01). The number of transplantable embnyos in the two groups were(1.9±0.5)and(2.3±0.4)respectively. The clinical pregnancy rates in micro-stimulation group and long-term regimen group were 40.5 %(34/84) and 50.4 %(57/113) respectively. The incidence of OHSS in two groups were 0(0/91) and 2.6 %(3/116) respectively. There was no significant difference between the two groups(P>0.05). Conclusion Patients with micro-stimulation ovulation induction can achieve the same therapeutic effect as patients with long-term regimen and reduce the incidence of OHSS. However, there are also some shortcomings such as the early onset of LH peak, which may lead to early ovulation or cancellation of cycle. Therefore, patients with normal ovarian function should be treated individually according to the specific conditions of patients in clinical practice.
引文
[1] 杨菁,冯亭亭,孙伟,等.3种不同超促排卵方案在高龄患者体外受精-胚胎移植中的临床效果分析 [J].现代妇产科进展,2016,25(11):830-833,837.
[2] 王靖,邢琼,王超,等.3种不同促排卵方案在高龄不孕患者IVF/ICSI-ET中的临床应用分析 [J].安徽医科大学学报,2018,53(7):1080-1084.
[3] YEUNG WS L R.Frozen-thawed embryo transfer cycles [J].Hong Kong Medical Journal = Xianggang yi xue za zhi /Hong Kong Academy of Medicine,2009,15 (6):420-426.
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[5] 庄素莲,荆春霞,纪丽伟,等.注射HCG日加用小剂量GnRHa对不孕症促排卵患者子宫内膜容受性和临床妊娠的影响 [J].山东医药,2019,59(2):61-64.
[6] 李艳辉,耿育红,陈莉娟,等.联合促性腺激素/枸橼酸氯米芬的非降调节卵巢刺激方案在卵巢反应不良患者中的应用 [J].生殖医学杂志,2017,26(8):777-783.
[7] 刘雷,王颖,杨东明.枸橼酸氯米芬,来曲唑对PCOS不孕患者的治疗效果比较 [J].中国现代药物应用,2016,10(24):130-131.
[8] 刘雷,王颖,杨东明.枸橼酸氯米芬加补佳乐治疗排卵障碍的治疗效果分析 [J].中国现代药物应用,2017,11(2):78-79.
[9] 孟丹.排卵汤联合枸橼酸氯米芬治疗多囊卵巢综合征不孕症及对患者β-绒毛膜促性腺激素水平影响 [J].辽宁中医药大学学报,2018,20(2):186-189.
[10] DEHBASHI S,PARSANEZHAD M E,ALBORZI S,et al.Effect of clomiphene citrate on endometrium thickness and echogenic patterns [J].International Journal of Gynecology & Obstetrics,2003,80 (1):49-53.
[11] 徐莹,官志芳.枸橼酸氯米芬、人类绝经期促性腺激素、人绒毛膜促性腺激素联合治疗内分泌失调性不孕症的效果观察 [J].中国医院用药评价与分析,2016,16(10):1336-1338.
[2] 王靖,邢琼,王超,等.3种不同促排卵方案在高龄不孕患者IVF/ICSI-ET中的临床应用分析 [J].安徽医科大学学报,2018,53(7):1080-1084.
[3] YEUNG WS L R.Frozen-thawed embryo transfer cycles [J].Hong Kong Medical Journal = Xianggang yi xue za zhi /Hong Kong Academy of Medicine,2009,15 (6):420-426.
[4] FERRARETD AP G L.Mild ovarian stimulation with clomiphene citrate launch is a realistic option for in vitro fertilization [J].Fertility and Sterility,2015,104 (2):333-338.
[5] 庄素莲,荆春霞,纪丽伟,等.注射HCG日加用小剂量GnRHa对不孕症促排卵患者子宫内膜容受性和临床妊娠的影响 [J].山东医药,2019,59(2):61-64.
[6] 李艳辉,耿育红,陈莉娟,等.联合促性腺激素/枸橼酸氯米芬的非降调节卵巢刺激方案在卵巢反应不良患者中的应用 [J].生殖医学杂志,2017,26(8):777-783.
[7] 刘雷,王颖,杨东明.枸橼酸氯米芬,来曲唑对PCOS不孕患者的治疗效果比较 [J].中国现代药物应用,2016,10(24):130-131.
[8] 刘雷,王颖,杨东明.枸橼酸氯米芬加补佳乐治疗排卵障碍的治疗效果分析 [J].中国现代药物应用,2017,11(2):78-79.
[9] 孟丹.排卵汤联合枸橼酸氯米芬治疗多囊卵巢综合征不孕症及对患者β-绒毛膜促性腺激素水平影响 [J].辽宁中医药大学学报,2018,20(2):186-189.
[10] DEHBASHI S,PARSANEZHAD M E,ALBORZI S,et al.Effect of clomiphene citrate on endometrium thickness and echogenic patterns [J].International Journal of Gynecology & Obstetrics,2003,80 (1):49-53.
[11] 徐莹,官志芳.枸橼酸氯米芬、人类绝经期促性腺激素、人绒毛膜促性腺激素联合治疗内分泌失调性不孕症的效果观察 [J].中国医院用药评价与分析,2016,16(10):1336-1338.
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