40岁以上女性黄体期促排卵周期IVF助孕结局临床观察
|
摘要
目的探讨≥40岁高龄女性在卵泡期促排卵取卵后连续进行黄体期促排卵的可行性。方法回顾性分析首都医科大学附属北京妇产医院2014年5月～2017年5月接受同一月经周期进行两次促排卵治疗(早卵泡期促排卵+黄体期促排卵)IVF助孕的、资料完整的64例高龄患者的所有统计学资料。按照促排卵起始时间不同将受试者分为两组:卵泡期促排卵组和黄体期促排卵组。比较各组基础数据,促排卵治疗的临床和实验室指标,以及冻融胚胎移植周期实验室和妊娠结局情况。结果共计120个周期、64例≥40岁高龄不孕患者的临床资料被纳入本研究。卵泡期促排卵组64个周期,随后进行黄体期促排卵组56个周期。两组间黄体期促排卵组hCG日LH水平和提前排卵率明显低于卵泡期促排卵组,组间差异存在统计学意义(P<0.05)。黄体期促排卵组获卵数和获卵率均明显高于卵泡期促排卵组,组间差异存在统计学意义(P<0.05)。两组患者的年龄、不孕年限、体质指数、基础FSH、基础E_2、窦卵泡数、hCG日E_2水平、MⅡ卵率、受精率、卵裂率、优质胚胎率、可利用胚胎率,未获卵率组间差异均未见统计学意义(P>0.05)。27例≥40岁高龄患者共计进行了29个周期的冻融胚胎移植,临床妊娠率13.79%,早期流产率25%,活产率10.34%。结论黄体期促排卵对≥40岁高龄患者是一个比较理想的治疗策略,能使这部分人群在较短时间内获得更多的卵母细胞,有助于改善其助孕妊娠结局。
Objective:To analyze the feasibility of luteal-phase ovarian stimulation in patients ≥40 years old. Methods:Retrospective study was conducted among 64 cases ≥40 years old in IVF-ET between May 2014 and May 2017 in Beijing Obstetrics and Gynecology Hospital,Capital Medical University. According to the ovulation initiation time,a total of 120 cycles were divided into two groups,follicular phase stimulation group(64 cycles)and luteal phase stimulation group(54 cycles). Results:The mean level of trigger luteinizing hormone(6.08±8.38 IU/L vs.2.84±2.35 IU/L,P<0.05)and the rate of advance ovulation(6.25% vs.0%,P<0.05)were lower in the luteal phase stimulation group than the follicular stimulation group. The mean number of oocytes retrieved(1.16±1.18 vs.1.71±1.44,P<0.05)and the oocyte retrieval rate per follicle(61.67% vs.73.28%,P<0.05)were higher in the luteal phase stimulation group than the follicular stimulation group. There was no significant difference in age,duration of infertility,body mass index(BMI),antral follicle count,serum basal follicle stimulating hormone(FSH)and estrogen(E_2)levels between the two groups(P>0.05). The mean level of trigger estrogen,the mature oocyte rate,the fertilization rate,the cleavage rate,the top-quality embryos rate,the cryopreserved embryos rate and cancellation rate obtained following follicular and luteal phase stimulation were all comparable(P>0.05). Conclusion:Luteal ovulation induction is an ideal treatment strategy for patients aged 40 years or more,which can make this part of the population obtain more oocytes in a relatively short period of time,and help improve its pregnancy outcome.
Objective:To analyze the feasibility of luteal-phase ovarian stimulation in patients ≥40 years old. Methods:Retrospective study was conducted among 64 cases ≥40 years old in IVF-ET between May 2014 and May 2017 in Beijing Obstetrics and Gynecology Hospital,Capital Medical University. According to the ovulation initiation time,a total of 120 cycles were divided into two groups,follicular phase stimulation group(64 cycles)and luteal phase stimulation group(54 cycles). Results:The mean level of trigger luteinizing hormone(6.08±8.38 IU/L vs.2.84±2.35 IU/L,P<0.05)and the rate of advance ovulation(6.25% vs.0%,P<0.05)were lower in the luteal phase stimulation group than the follicular stimulation group. The mean number of oocytes retrieved(1.16±1.18 vs.1.71±1.44,P<0.05)and the oocyte retrieval rate per follicle(61.67% vs.73.28%,P<0.05)were higher in the luteal phase stimulation group than the follicular stimulation group. There was no significant difference in age,duration of infertility,body mass index(BMI),antral follicle count,serum basal follicle stimulating hormone(FSH)and estrogen(E_2)levels between the two groups(P>0.05). The mean level of trigger estrogen,the mature oocyte rate,the fertilization rate,the cleavage rate,the top-quality embryos rate,the cryopreserved embryos rate and cancellation rate obtained following follicular and luteal phase stimulation were all comparable(P>0.05). Conclusion:Luteal ovulation induction is an ideal treatment strategy for patients aged 40 years or more,which can make this part of the population obtain more oocytes in a relatively short period of time,and help improve its pregnancy outcome.
引文
[1]Tsafrir A,Simon A,Revel A,et al. Retrospective analysis of 1217IVF cycles in women aged 40 years and older[J]. Reprod Biomed Online,2007,14(3):348-55.
[2]Bou Nemer L,Weitzman VN,Arheart KL,et al. In Vitro Fertilization Versus Mild Stimulation Intrauterine Insemination in Women Aged 40 and Older[J]. Reprod Sci,2017,24(4):609-612.
[3]Smith ADAC,Tilling K,Nelson SM,et al. Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles[J].JAMA,2015,314(24):2654-2662.
[4]兰永连,梁毓,李颖,等.超过40岁女性超促排卵卵巢反应性影响因素分析[J].中国优生与遗传杂志,2016,24(06):108-110.
[5]Cohen Y,Tannus S,Alzawawi N,et al. Poor ovarian response as a predictor for live birth in older women undergoing IVF[J]. Reprod Biomed Online,2018,36(4):435-441.
[6]Lee Y,Kim TH,Park JK,et al. Predictive value of antral follicle count and serum anti-Müllerian hormone:Which is better for live birth prediction in patients aged over 40 with their first IVF treatment?[J]. Eur J Obstet Gynecol Reprod Biol,2018,221:151-155.
[7]TannusS,TanJ,SonWY,etal.Prevalence,clinical characteristics,and reproductive outcomes of polycystic ovary syndrome in older women referred for tertiary fertility care[J]. Arch Gynecol Obstet,2018,297(4):1037-1042.
[8]Baerwald AR,Adams GP,Pierson RA. Characterization of ovarian follicular wave dynamics in women[J]. Biol Reprod,2003,69(3):1023-31.
[9]Baerwald AR,Adams GP,Pierson RA. A new model for ovarian follicular development during the human menstrual cycle[J]. Fertil Steril,2003,80(1):116-22.
[10] Kuang Y,Chen Q,Hong Q,et al. Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes(Shanghai protocol)[J]. Reprod Biomed Online,2014,29:684-691.
[11] Ubaldi FM,Capalbo A,Vaiarelli A,et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle(DuoStim)in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate:new insight in ovarian reserve exploitation[J]. Fertil Steril,2016,105:1488-1495.
[12] Wang Y,Chen Q,Wang N,et al. Controlled ovarian stimulation using medroxyprogesterone acetate and hMG in patients with polycystic ovary syndrome treated for IVF:a double-blind randomized crossover clinical trial[J]. Medicine(Baltimore),2016,95:e2939.
[13] Wu Y,Kang X,Zheng H,et al. Effect of Paternal Age on Reproductive Outcomes of Intracytoplasmic Sperm Injection[J].PLoS One,2016,11(2):e0149867.
[14] Wu Y,Kang X,Zheng H,et al. Effect of Paternal Age on Reproductive Outcomes of In Vitro Fertilization[J]. PLoS One,2015,10(9):e0135734.
[15] Rashtian J,Zhang J. Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve[J]. Syst Biol Reprod Med,2018,64(3):216-219.
[2]Bou Nemer L,Weitzman VN,Arheart KL,et al. In Vitro Fertilization Versus Mild Stimulation Intrauterine Insemination in Women Aged 40 and Older[J]. Reprod Sci,2017,24(4):609-612.
[3]Smith ADAC,Tilling K,Nelson SM,et al. Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles[J].JAMA,2015,314(24):2654-2662.
[4]兰永连,梁毓,李颖,等.超过40岁女性超促排卵卵巢反应性影响因素分析[J].中国优生与遗传杂志,2016,24(06):108-110.
[5]Cohen Y,Tannus S,Alzawawi N,et al. Poor ovarian response as a predictor for live birth in older women undergoing IVF[J]. Reprod Biomed Online,2018,36(4):435-441.
[6]Lee Y,Kim TH,Park JK,et al. Predictive value of antral follicle count and serum anti-Müllerian hormone:Which is better for live birth prediction in patients aged over 40 with their first IVF treatment?[J]. Eur J Obstet Gynecol Reprod Biol,2018,221:151-155.
[7]TannusS,TanJ,SonWY,etal.Prevalence,clinical characteristics,and reproductive outcomes of polycystic ovary syndrome in older women referred for tertiary fertility care[J]. Arch Gynecol Obstet,2018,297(4):1037-1042.
[8]Baerwald AR,Adams GP,Pierson RA. Characterization of ovarian follicular wave dynamics in women[J]. Biol Reprod,2003,69(3):1023-31.
[9]Baerwald AR,Adams GP,Pierson RA. A new model for ovarian follicular development during the human menstrual cycle[J]. Fertil Steril,2003,80(1):116-22.
[10] Kuang Y,Chen Q,Hong Q,et al. Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes(Shanghai protocol)[J]. Reprod Biomed Online,2014,29:684-691.
[11] Ubaldi FM,Capalbo A,Vaiarelli A,et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle(DuoStim)in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate:new insight in ovarian reserve exploitation[J]. Fertil Steril,2016,105:1488-1495.
[12] Wang Y,Chen Q,Wang N,et al. Controlled ovarian stimulation using medroxyprogesterone acetate and hMG in patients with polycystic ovary syndrome treated for IVF:a double-blind randomized crossover clinical trial[J]. Medicine(Baltimore),2016,95:e2939.
[13] Wu Y,Kang X,Zheng H,et al. Effect of Paternal Age on Reproductive Outcomes of Intracytoplasmic Sperm Injection[J].PLoS One,2016,11(2):e0149867.
[14] Wu Y,Kang X,Zheng H,et al. Effect of Paternal Age on Reproductive Outcomes of In Vitro Fertilization[J]. PLoS One,2015,10(9):e0135734.
[15] Rashtian J,Zhang J. Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve[J]. Syst Biol Reprod Med,2018,64(3):216-219.