卵泡期联合黄体期促排卵对卵巢低反应患者活产率的影响
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摘要
目的探讨卵泡期联合黄体期促排卵在体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)周期中对卵巢低反应(POR)患者活产率的影响。方法回顾性分析2014年1月至2016年12月于我院生殖中心行IVF/ICSI的713位POR患者713周期的数据资料,根据促排卵方案分为2组:单纯卵泡期微刺激促排卵组(单纯组)和卵泡期微刺激联合黄体期促排卵组(联合组),比较2组间每周期的获卵数、受精率、可利用胚胎数、周期取消率,及每起始周期的累积临床妊娠率、活产率及流产率。结果联合组每周期的获卵数[(3.5±2.0)vs.(1.7±1.2)]及可利用胚胎数[((2.1±1.4)vs.(1.1±1.0)]均显著高于单纯组(P<0.05),周期取消率显著低于单纯组(15.6%vs.31.3%,P<0.05)。联合组每起始周期的累积临床妊娠率显著高于单纯组(22.7%vs.14.8%,P<0.05);累积活产率较单纯组有升高的趋势(17.7%vs.11.6%),但未达到显著性差异(P>0.05);流产率两组间无显著性差异(P>0.05)。结论卵泡期微刺激促排卵联合黄体期促排卵可显著增加卵巢低反应患者每周期的累积妊娠率,提高活产率。
Objective:To investigate the effect of ovulation induction during follicular phase combined luteal phase on live-birth rate in the patients with poor ovarian response(POR)undergoing IVF/ICSI-ET.Methods:The data of 713 IVF/ICSI cycles of 713 POR patients in our reproductive center from January 2014 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to ovarian stimulation protocol:mini-ovarian stimulation in follicular phase group(follicular phase group)and ovarian stimulation during follicular phase combined with luteal phase group(combined group).The number of oocytes per cycle,fertilization rate,number of available embryos and cycle cancellation rate were compared between the two groups,and accumulative pregnancy rate,live birth rate and abortion rate were also compared.Results:The number of oocytes per cycle[(3.5±2.0)vs.(1.7±1.2)]and the number of available embryos[(2.1±1.4)vs.(1.1±1.0)]in the combined group were significantly higher than those in the follicular phase group(P<0.05),and the cancellation rate was significantly reduced in the combined group(15.6% vs.31.3%,P<0.05).The accumulative clinical pregnancy rate(22.7%vs.14.8%)per starting cycle in combined group were significantly higher than that in the follicular phase group(P<0.05),and the accumulative live birth rate(17.7% vs.11.6%)had a trend of increase in combined group compared with the follicular phase group,but there was no significant difference(P>0.05).The abortion rate was similar between the two groups(P>0.05).Conclusions: The ovulation induction during follicular phase combined with luteal phase can significantly increase the accumulative clinical pregnancy rate per cycle and the accumulative live birth rate.
Objective:To investigate the effect of ovulation induction during follicular phase combined luteal phase on live-birth rate in the patients with poor ovarian response(POR)undergoing IVF/ICSI-ET.Methods:The data of 713 IVF/ICSI cycles of 713 POR patients in our reproductive center from January 2014 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to ovarian stimulation protocol:mini-ovarian stimulation in follicular phase group(follicular phase group)and ovarian stimulation during follicular phase combined with luteal phase group(combined group).The number of oocytes per cycle,fertilization rate,number of available embryos and cycle cancellation rate were compared between the two groups,and accumulative pregnancy rate,live birth rate and abortion rate were also compared.Results:The number of oocytes per cycle[(3.5±2.0)vs.(1.7±1.2)]and the number of available embryos[(2.1±1.4)vs.(1.1±1.0)]in the combined group were significantly higher than those in the follicular phase group(P<0.05),and the cancellation rate was significantly reduced in the combined group(15.6% vs.31.3%,P<0.05).The accumulative clinical pregnancy rate(22.7%vs.14.8%)per starting cycle in combined group were significantly higher than that in the follicular phase group(P<0.05),and the accumulative live birth rate(17.7% vs.11.6%)had a trend of increase in combined group compared with the follicular phase group,but there was no significant difference(P>0.05).The abortion rate was similar between the two groups(P>0.05).Conclusions: The ovulation induction during follicular phase combined with luteal phase can significantly increase the accumulative clinical pregnancy rate per cycle and the accumulative live birth rate.
引文
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[14]李冬宏,卢淑庄,林彤,等.黄体期促排卵在卵巢低反应高龄患者中的应用效果研究[J].生殖医学杂志,2017,26:1041-1043.
[2] Zhang Q,Guo XM,Li Y.Implantation rates subsequent to the transfer of embryos produced at different phases during double stimulation of poor ovarian responders[J].Reprod Fertil Dev,2017,29:1178-1183.
[3] Jin B,Niu Z,Xu B,et al.Comparison of clinical outcomes among dual ovarian stimulation,mild stimulation and luteal phase stimulation protocols in women with poor ovarian response[J].Gynecol Endocrinol,2018,34:694-697.
[4] Cummins JM,Breen TM,Harrison KL,et al.A formula for scoring human embryo growth rates in in vitro fertilization:its value in predicting pregnancy and in comparison with visual estimates of embryo quality[J].J In Vitro Fert Embryo Transf,1986,3:284-295.
[5] Gougeon A.Dynamics of follicular growth in the human:a model from preliminary results[J].Hum Reprod,1986,1:81-87.
[6]韩文菊,王磊,邵小光.卵巢储备功能减退患者继续黄体期促排卵的临床观察[J].生殖与避孕,2016,36:1040-1043.
[7]乔宗惠,吴丽敏,庞丽娥,等.卵巢储备功能下降患者应用双刺激方案、微刺激方案、黄体期促排方案的妊娠结局比较[J].生殖医学杂志,2017,26:433-437.
[8]李玉梅,巴林林,刘冬娥,等.卵泡期联合黄体期促排卵在卵巢储备功能减退患者实施辅助生殖技术中的应用[J].生殖医学杂志,2014,23:728-732.
[9] Demirtas E,Elizur SE,Holzer H,et al.Immature oocyte retrieval in the luteal phase to preserve fertility in cancer patients[J/OL].Reprod Biomed Online,2008,17:520-523.
[10] Chian RC,Chung JT,Downey BR,et al.Maturational and developmental competence of immature oocytes retrieved from bovine ovaries at different phases of folliculogenesis[J/OL].Reprod Biomed Online,2002,4:127-132.
[11] 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/OL]. Reprod Biomed Online,2014,29:684-691.
[12]刘英,林慧,雷金风.黄体期促排卵在卵巢低反应患者中的应用[J].中国妇幼保健,2018,33:148-150.
[13] 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.
[14]李冬宏,卢淑庄,林彤,等.黄体期促排卵在卵巢低反应高龄患者中的应用效果研究[J].生殖医学杂志,2017,26:1041-1043.