不同促排卵方案对卵巢子宫内膜异位囊肿术后卵巢储备功能下降患者IVF-ET助孕结局的影响
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摘要
目的探讨不同促排卵方案对卵巢子宫内膜异位囊肿剔除术后卵巢储备功能下降(Diminished ovarian reserve,DOR)患者体外受精-胚胎移植(In vitro fertilization-embryo transfer,IVF-ET)助孕结局的影响。方法回顾性分析2015年1月至2017年12月201个卵巢子宫内膜异位囊肿剔除术后DOR患者IVF助孕周期的临床资料。根据促排卵方案不同分为超长方案组(n=101)和拮抗剂方案组(n=100),比较两组患者的一般情况、获卵数、受精率和妊娠结局等指标。结果两组患者的年龄、不孕年限、基础内分泌(FSH、LH、E2)、窦卵泡计数(Antralfolliclecount,AFC)均无明显统计学差异(P>0.05)。拮抗剂组促性腺激素(Gonadotropin,Gn)使用天数,Gn用量均少于超长方案组(P<0.05),获卵数、卵子成熟率、受精率均无统计学差异(P>0.05)。超长方案组和拮抗剂组临床妊娠率分别为46.48%和31.43%,流产率分别为8.82%和9.09%,差异均无统计学意义(P>0.05)。结论对于卵巢子宫内膜异位囊肿剔除术后卵巢储备功能下降的患者,超长方案和拮抗剂方案均能获得较好的妊娠结局。拮抗剂方案用药较少促排卵时间较短;超长方案妊娠率略高,由于样本量的限制,有待进一步扩大样本研究。
Objective:To investigate the effect of different controlled ovarian stimulation(COS)protocols on the clinical outcome of in vitro fertilization-embryo transfer(IVF-ET)in diminished ovarian reserve(DOR)patients who underwent ovarian endometriosis cystectomy. Methods:A total of 201 patients underwent IVF-ET treatment in Beijing Obstetrics and Gynecology Hospital from January 1,2015 to December 31,2017 were included in this retrospective study. The patients were divided into two groups according to the COS protocols,prolonged GnRH-agonists(GnRH-a,n=101)and GnRH-antagonist(GnRH-ant,n=100)groups. The clinical and laboratory parameters of different protocols were analyzed. Results:There was no significant difference in the age,infertility duration,basic follicle-stimulation hormone,luteinizing hormone and estradiol levels,as well as antral follicle count(AFC)(P>0.05). The total gonadotrophin(Gn)dosage and duration tended to be higher in prolonged GnRH-a group than another one(P<0.05). But no obvious difference was found in the number of retrieval oocyte,oocyte maturation rate and fertilization rate(P>0.05). The clinical pregnancy rates in prolonged GnRH-a group and GnRH-ant group were 46.48% and 31.43% respectively,while the abortion rates were 8.82% and 9.09%. These two rates both showed no significant difference(P>0.05). Conclusion:For those DOR patients who underwent ovarian endometriosis cystectomy,GnRHant protocol can achieve similar clinical IVF-ET outcomes as prolonged GnRH-a protocol but reduce the cost and time of drug treatment at same time. prolonged GnRH-a protocol has a bit higher pregnancy rate,however,a larger sample size may be needed for the further study.
Objective:To investigate the effect of different controlled ovarian stimulation(COS)protocols on the clinical outcome of in vitro fertilization-embryo transfer(IVF-ET)in diminished ovarian reserve(DOR)patients who underwent ovarian endometriosis cystectomy. Methods:A total of 201 patients underwent IVF-ET treatment in Beijing Obstetrics and Gynecology Hospital from January 1,2015 to December 31,2017 were included in this retrospective study. The patients were divided into two groups according to the COS protocols,prolonged GnRH-agonists(GnRH-a,n=101)and GnRH-antagonist(GnRH-ant,n=100)groups. The clinical and laboratory parameters of different protocols were analyzed. Results:There was no significant difference in the age,infertility duration,basic follicle-stimulation hormone,luteinizing hormone and estradiol levels,as well as antral follicle count(AFC)(P>0.05). The total gonadotrophin(Gn)dosage and duration tended to be higher in prolonged GnRH-a group than another one(P<0.05). But no obvious difference was found in the number of retrieval oocyte,oocyte maturation rate and fertilization rate(P>0.05). The clinical pregnancy rates in prolonged GnRH-a group and GnRH-ant group were 46.48% and 31.43% respectively,while the abortion rates were 8.82% and 9.09%. These two rates both showed no significant difference(P>0.05). Conclusion:For those DOR patients who underwent ovarian endometriosis cystectomy,GnRHant protocol can achieve similar clinical IVF-ET outcomes as prolonged GnRH-a protocol but reduce the cost and time of drug treatment at same time. prolonged GnRH-a protocol has a bit higher pregnancy rate,however,a larger sample size may be needed for the further study.
引文
[1]子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[2]Uncu G,Kasapoglu I,Ozerkan K,et al. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve[J]. Hum Reprod,2013,28(8):2140-2145.
[3]Urman B,Alper E,Yakin K,et al. Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve[J]. Reproductive Biomedicine Online,2013,27(2):212-216.
[4]Zhang H H,Xu P Y,Wu J,et al. Dehydroepiandrosterone improves follicular fluid bone morphogenetic protein-15 and accumulated embryo score of infertility patients with diminished ovarian reserve undergoing in vitro fertilization:a randomized controlled trial[J]. Journal of Ovarian Research,2014,7(1):93-100.
[5]Senapati S,Sammel MD,Morse C,et al. Impact of endometriosis on in vitro fertilization outcomes:an evaluation of the Society for Assisted Reproductive Technologies Database[J]. Fertility&Sterility,2016,106(1):164-171.
[6]Van der Houwen L.E.E,Mijatovic V,Leemhuis E,et al. Efficacy and safety of IVF/ICSI in patients with severe endometriosis after long-term pituitary down-regulation[J]. Reproductive Biomedicine Online,2014,28(1):39-46.
[7]Tamura H,Takasaki A,Nakamura Y,et al. A pilot study to search possible mechanisms of ultralong gonadotropin-releasing hormone agonist therapy in IVF-ET patients with endometriosis[J]. Journal of Ovarian Research,2014,7(1):100-105.
[8]Ren J,Sha A,Han D,et al. Does prolonged pituitary downregulation with gonadotropin-releasing hormone agonist improve the live-birth rate in in vitro fertilization treatment?[J]. Fertility&Sterility,2014,102(1):75-81.
[9]Copperman A B,Benadiva C. Optimal usage of the GnRH antagonists:a review of the literature[J]. Reproductive Biology&Endocrinology,2013,11(1):20-32.
[10] Reichman DE,Zakarin L,Chao K,et al. Diminished ovarian reserve is the predominant risk factor for gonadotropin-releasing hormone antagonist failure resulting in breakthrough luteinizing hormone surges in in vitro fertilization cycles[J]. Fertility&Sterility,2014,102(1):99-102.
[11] Rackow BW,Kliman HJ,Taylor HS. GnRH antagonists may affect endometrial receptivity[J]. Fertility and Sterility,2008,89(5):1234-1239.
[2]Uncu G,Kasapoglu I,Ozerkan K,et al. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve[J]. Hum Reprod,2013,28(8):2140-2145.
[3]Urman B,Alper E,Yakin K,et al. Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve[J]. Reproductive Biomedicine Online,2013,27(2):212-216.
[4]Zhang H H,Xu P Y,Wu J,et al. Dehydroepiandrosterone improves follicular fluid bone morphogenetic protein-15 and accumulated embryo score of infertility patients with diminished ovarian reserve undergoing in vitro fertilization:a randomized controlled trial[J]. Journal of Ovarian Research,2014,7(1):93-100.
[5]Senapati S,Sammel MD,Morse C,et al. Impact of endometriosis on in vitro fertilization outcomes:an evaluation of the Society for Assisted Reproductive Technologies Database[J]. Fertility&Sterility,2016,106(1):164-171.
[6]Van der Houwen L.E.E,Mijatovic V,Leemhuis E,et al. Efficacy and safety of IVF/ICSI in patients with severe endometriosis after long-term pituitary down-regulation[J]. Reproductive Biomedicine Online,2014,28(1):39-46.
[7]Tamura H,Takasaki A,Nakamura Y,et al. A pilot study to search possible mechanisms of ultralong gonadotropin-releasing hormone agonist therapy in IVF-ET patients with endometriosis[J]. Journal of Ovarian Research,2014,7(1):100-105.
[8]Ren J,Sha A,Han D,et al. Does prolonged pituitary downregulation with gonadotropin-releasing hormone agonist improve the live-birth rate in in vitro fertilization treatment?[J]. Fertility&Sterility,2014,102(1):75-81.
[9]Copperman A B,Benadiva C. Optimal usage of the GnRH antagonists:a review of the literature[J]. Reproductive Biology&Endocrinology,2013,11(1):20-32.
[10] Reichman DE,Zakarin L,Chao K,et al. Diminished ovarian reserve is the predominant risk factor for gonadotropin-releasing hormone antagonist failure resulting in breakthrough luteinizing hormone surges in in vitro fertilization cycles[J]. Fertility&Sterility,2014,102(1):99-102.
[11] Rackow BW,Kliman HJ,Taylor HS. GnRH antagonists may affect endometrial receptivity[J]. Fertility and Sterility,2008,89(5):1234-1239.