微刺激方案中克罗米芬促排卵5天后内源性FSH的变化及结局分析
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摘要
目的探讨克罗米芬(CC)联合人绝经期促性腺激素(HMG)微刺激方案中应用CC促排卵5d后内源性FSH变化情况及其与促排卵结局的相关性。方法回顾性分析2015年1~5月在南京大学医学院附属鼓楼医院生殖医学中心行CC+HMG微刺激促排卵的156例患者的临床资料,以CC促排卵5d[即月经周期第7天(D7)]内源性FSH的变化分为FSH上升组与FSH下降组;同时将基础D2FSH≥10U/L的患者根据FSH水平变化分为FSH上升组(A组)与FSH下降组(B组),将D2FSH<10U/L的患者根据FSH水平变化分为FSH上升组(C组)与FSH下降组(D组),比较各组患者的促排卵结局。结果 156例患者中CC促排卵5d后FSH上升者占53.2%,下降者占46.8%。FSH下降组的D2FSH、D2LH水平、D7E2水平显著高于FSH上升组,FSH下降组的D7FSH、HCG日FSH水平显著低于FSH上升组(P<0.05);FSH下降组的促排卵天数及Gn用量亦显著少于FSH上升组(P<0.05)。B组的基础窦卵泡数(AFC)、D7E2显著高于A组,D7FSH、HCG日FSH、HCG日LH、促排天数显著低于A组(P<0.05);B组的获卵数及冷冻胚胎数显著高于A组(P<0.05)。C、D两组除D2FSH、D7FSH有显著性差异外(P<0.05),其余指标均无显著性差异(P>0.05)。结论 CC+HMG微刺激方案中应用CC促排卵5d后内源性FSH上升与降低都是常见的卵巢反应,对于D2FSH≥10U/L的患者,D7内源性FSH水平变化可用于评价卵巢的储备功能。
Objective: To explore the correlation between IVF outcomes and the changes of endogenous FSH at 5days after ovulation induction with clomiphene citrate(CC).Methods: A total of 156 patients using CC + HMG mini-stimulation protocol in Reproductive Medicine Center of Drum Tower Hospital Affiliated to Nanjing University Medical School from January2015 to May 2015 were enrolled.The patients were divided into two groups according to the changes of endogenous FSH at 5days after ovulation induction with CC(menstrual cycle Day 7):FSH rising group and FSH declined group.The patients were divided into FSH rising group(group A)and FSH declined group(group B)in the patients with FSH levels≥10U/L on Day 2,while the patients were divided into FSH rising group(group C)and FSH declined group(group D)in the patients with FSH levels<10U/L on Day 2.The ovulation outcomes were compared among the groups.Results: The endogenous FSH levels in 53.2% patients were increased,and decreased in 46.8%patients at 5days after ovulation induction with CC among the 156 patients.The FSH & LH levels on Day2 and E2levels on Day 7in the FSH declined group were significantly higher than those in FSH rising group(P<0.05).FSH levels on Day 7or HCG day in the FSH declined group were significantly lower than those in the FSH rising group(P<0.05).The induced ovulation days and gonadotropin(Gn)doses used in FSH declined group were significantly less than the FSH rising group(P<0.05).The antral follicle count(AFC)and E2 levels on Day 7in group B were significantly higher than those in group A(P<0.05).The FSH levels on Day 7or HCG day,LH levels on HCG day,and induced ovulation days in group B were significantly lower than those in group A(P<0.05).The number of oocytes retrieved and the number of frozen embryos in group B were significantly higher than those in group A(P<0.05).However,there was no significant difference in the indexes(P>0.05)except FSH levels on Day 2or Day7 between group C and group D(P<0.05).Conclusions: After 5days of CC ovulation induction,the level of endogenous FSH increased or decreased are common for ovarian responses in CC+HMG protocol.Endogenous FSH levels variation after5 days of CC ovulation induction can be used to evaluate ovarian reserve function in the patients with FSH≥10U/L on Day 2.
Objective: To explore the correlation between IVF outcomes and the changes of endogenous FSH at 5days after ovulation induction with clomiphene citrate(CC).Methods: A total of 156 patients using CC + HMG mini-stimulation protocol in Reproductive Medicine Center of Drum Tower Hospital Affiliated to Nanjing University Medical School from January2015 to May 2015 were enrolled.The patients were divided into two groups according to the changes of endogenous FSH at 5days after ovulation induction with CC(menstrual cycle Day 7):FSH rising group and FSH declined group.The patients were divided into FSH rising group(group A)and FSH declined group(group B)in the patients with FSH levels≥10U/L on Day 2,while the patients were divided into FSH rising group(group C)and FSH declined group(group D)in the patients with FSH levels<10U/L on Day 2.The ovulation outcomes were compared among the groups.Results: The endogenous FSH levels in 53.2% patients were increased,and decreased in 46.8%patients at 5days after ovulation induction with CC among the 156 patients.The FSH & LH levels on Day2 and E2levels on Day 7in the FSH declined group were significantly higher than those in FSH rising group(P<0.05).FSH levels on Day 7or HCG day in the FSH declined group were significantly lower than those in the FSH rising group(P<0.05).The induced ovulation days and gonadotropin(Gn)doses used in FSH declined group were significantly less than the FSH rising group(P<0.05).The antral follicle count(AFC)and E2 levels on Day 7in group B were significantly higher than those in group A(P<0.05).The FSH levels on Day 7or HCG day,LH levels on HCG day,and induced ovulation days in group B were significantly lower than those in group A(P<0.05).The number of oocytes retrieved and the number of frozen embryos in group B were significantly higher than those in group A(P<0.05).However,there was no significant difference in the indexes(P>0.05)except FSH levels on Day 2or Day7 between group C and group D(P<0.05).Conclusions: After 5days of CC ovulation induction,the level of endogenous FSH increased or decreased are common for ovarian responses in CC+HMG protocol.Endogenous FSH levels variation after5 days of CC ovulation induction can be used to evaluate ovarian reserve function in the patients with FSH≥10U/L on Day 2.
引文
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[11]Abdelazim IA,Makhlouf HH.Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women[J].Arch Gynecol Obstet,2013,287:591-597.
[12]Teramoto S,Kato O.Minimal ovarian stimulation with clomiphene citrate:a large-scale retrospective study[J/OL].Reprod Biomed Online,2007,15:134-148.
[13]Song D,Shi Y,Zhong Y,et al.Efficiency of mild ovarian stimulation with clomiphene on poor ovarian responders during IVF\ICSI procedures:a meta-analysis[J].Eur JObstet Gynecol Reprod Biol,2016,204:36-43.
[14]Gibreel A,Maheshwari A,Bhattacharya S.Clomiphene citrate in combination with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilization[J].Cochrane Database Syst Rev,2012,11:CD008528.
[15]程萍,张昌军.抑制素B与生殖[J].生殖医学杂志,2007,16:205-208.
[16]Baird DT,Campbell BK,Mann GE,et al.Inhibin and oestradiol in the control of FSH secretion in the sheep[J].J Reprod Fertil Suppl,1991,43:125-138.
[17]门鸿芹,范莹露,腊晓琳.克罗米芬在体外受精-胚胎移植方案中的应用[J].生殖与避孕,2015,35:504-508.
[2]高彦,冒韵东,王媁,等.卵巢功能减退患者采用自然周期或微刺激方案治疗策略及结局[J].生殖医学杂志,2016,25:897-900.
[3]孙丽君,孙慧霞,钱秋然,等.微刺激促排卵方案在PCOS患者IVF中的应用[J].生殖与避孕,2011,31:635-639.
[4]李红真,乔杰,甄秀梅.重新评价克罗米芬在促排卵治疗中的作用[J].生殖医学杂志,2008,17:428-430.
[5]Ferraretti AP,Gianaroli L,Magli MC,et al.Mild ovarian stimulation with clomiphene citrate launch is a realistic option for in vitro fertilization[J].Fertil Steril,2015,104:333-338.
[6]高彦,冒韵东,王媁,等.反复体外受精-胚胎移植治疗失败患者采用微刺激方案妊娠结局[J].生殖医学杂志,2012,21:34-37.
[7]Pal L,Zhang K,Zeitlian G,et al.Characterizing the reproductive hormone milieu in infertile women with diminished ovarian reserve[J].Fertil Steril,2010,93:1074-1079.
[8]乔杰,马彩虹,刘嘉茵,等.辅助生殖促排卵药物治疗专家共识[J].生殖与避孕,2015,35:211-223.
[9]Kara M,Kutlu T,Sofuoglu K,et al.Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome[J].Iran J Reprod Med,2012,10:53-58.
[10]周建军,王玢,陈华,等.携带9号染色体臂间倒位的不孕症夫妇IVF/ICSI结局分析[J].生殖医学杂志,2015,24:885-889.
[11]Abdelazim IA,Makhlouf HH.Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women[J].Arch Gynecol Obstet,2013,287:591-597.
[12]Teramoto S,Kato O.Minimal ovarian stimulation with clomiphene citrate:a large-scale retrospective study[J/OL].Reprod Biomed Online,2007,15:134-148.
[13]Song D,Shi Y,Zhong Y,et al.Efficiency of mild ovarian stimulation with clomiphene on poor ovarian responders during IVF\ICSI procedures:a meta-analysis[J].Eur JObstet Gynecol Reprod Biol,2016,204:36-43.
[14]Gibreel A,Maheshwari A,Bhattacharya S.Clomiphene citrate in combination with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilization[J].Cochrane Database Syst Rev,2012,11:CD008528.
[15]程萍,张昌军.抑制素B与生殖[J].生殖医学杂志,2007,16:205-208.
[16]Baird DT,Campbell BK,Mann GE,et al.Inhibin and oestradiol in the control of FSH secretion in the sheep[J].J Reprod Fertil Suppl,1991,43:125-138.
[17]门鸿芹,范莹露,腊晓琳.克罗米芬在体外受精-胚胎移植方案中的应用[J].生殖与避孕,2015,35:504-508.