不同降调节方案对卵巢子宫内膜异位囊肿患者IVF/ICSI-ET结局影响的回顾性分析
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摘要
目的探讨不同降调节方案应用于卵巢子宫内膜异位囊肿(简称巧囊)患者的IVF/ICSI-ET妊娠结局。方法收集2011年1月至2014年12月在中山大学孙逸仙纪念医院生殖医学中心行IVF/ICSI-ET的325名巧囊患者(共372个周期)为研究对象。根据纳入对象情况,分为3组:IVF/ICSI周期中存在巧囊且既往未行巧囊剔除术者为巧囊组(A组,90个周期);既往曾行单侧或双侧巧囊剔除术且术后复发者为巧囊剔除术后复发组(B组,92个周期);术后巧囊未复发者为巧囊剔除术后未复发组(C组,190个周期)。每组中再根据降调节方案的不同分为超长方案亚组:A1、B1和C1组,长方案亚组:A2、B2和C2组。比较各组中不同促排卵方案的促排卵情况及妊娠结局。结果 A1组和A2组的获卵数、种植率和临床妊娠率等均无显著性差异(P>0.05)。B1组的HCG日E2水平、获卵数、MⅡ卵母细胞数和可利用胚胎数均显著低于B2组(P<0.05),两组种植率和临床妊娠率无显著性差异(P>0.05)。C1组的获卵数、MⅡ卵母细胞数、可利用胚胎数均显著低于C2组(P<0.05),两组的种植率、临床妊娠率和早期流产率均无显著性差异(P>0.05)。结论长方案降调节应用于巧囊患者的妊娠结局与超长方案相似,可作为优选方案之一,特别是对于巧囊剔除术后的患者。
Objective:To investigate the impact of different down-regulation protocols on the IVF/ICSI-ET outcomes of patients with ovarian endometrioma.Methods:The data of the patients with ovarian endometrioma treated with IVF/ICSI-ET in the reproductive center of Sun Yat-sen Memorial Hospital from January 2011 to December 2014 were collected and retrospectively analyzed.A total of 372 cycles were included and divided into three groups:the patients with ovarian endometrioma during IVF cycle and without history of ovarian endometrioma excision in group A(n=90),those with ovarian endometrioma and history of ovarian endometrioma excision in group B(n=92),those with history of ovarian endometrioma excision but no recurrence in group C(n=190).The patients in group A,B and C were further divided into two subgroups respectively:those with prolong down-regulation protocol in group A1,B1 and C1,the others with long down-regulation protocol in group A2,B2 and C2.The ovulation induction status and pregnancy outcomes of different down-regulation protocol were compared among the groups.Results:The number of oocyte retrieved,implantation rate and clinical pregnancy rate had no significant difference between group A1 and A2(P>0.05).The E2 level on HCG day,number of oocyte retrieved,MⅡ oocyte and available embryo in group B1 were significantly lower than those in group B2(P<0.05).However,there was no significant difference in implantation rate and clinical pregnancy rate between group B1 and B2(P>0.05).The number of oocyte,MⅡoocyte and available embryo in group C1 were significantly lower than those in group C2(P <0.05).There was no significant difference in implantation rate,clinical pregnancy rate and early abortion rate between the two subgroups(P>0.05).Conclusions: Long down-regulation protocol may be a good choice for patients with ovarian endometrioma during treatment of IVF/ICSI-ET,because its pregnancy outcomes were similar with prolong down-regulation protocol,especially for patients after the ovarian endometrioma excision.
Objective:To investigate the impact of different down-regulation protocols on the IVF/ICSI-ET outcomes of patients with ovarian endometrioma.Methods:The data of the patients with ovarian endometrioma treated with IVF/ICSI-ET in the reproductive center of Sun Yat-sen Memorial Hospital from January 2011 to December 2014 were collected and retrospectively analyzed.A total of 372 cycles were included and divided into three groups:the patients with ovarian endometrioma during IVF cycle and without history of ovarian endometrioma excision in group A(n=90),those with ovarian endometrioma and history of ovarian endometrioma excision in group B(n=92),those with history of ovarian endometrioma excision but no recurrence in group C(n=190).The patients in group A,B and C were further divided into two subgroups respectively:those with prolong down-regulation protocol in group A1,B1 and C1,the others with long down-regulation protocol in group A2,B2 and C2.The ovulation induction status and pregnancy outcomes of different down-regulation protocol were compared among the groups.Results:The number of oocyte retrieved,implantation rate and clinical pregnancy rate had no significant difference between group A1 and A2(P>0.05).The E2 level on HCG day,number of oocyte retrieved,MⅡ oocyte and available embryo in group B1 were significantly lower than those in group B2(P<0.05).However,there was no significant difference in implantation rate and clinical pregnancy rate between group B1 and B2(P>0.05).The number of oocyte,MⅡoocyte and available embryo in group C1 were significantly lower than those in group C2(P <0.05).There was no significant difference in implantation rate,clinical pregnancy rate and early abortion rate between the two subgroups(P>0.05).Conclusions: Long down-regulation protocol may be a good choice for patients with ovarian endometrioma during treatment of IVF/ICSI-ET,because its pregnancy outcomes were similar with prolong down-regulation protocol,especially for patients after the ovarian endometrioma excision.
引文
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[12]Pabuccu R,Onalan G,Kaya C.GnRH agonist and antagonist protocols for stage I-II endometriosis and endometrioma in in vitro fertilization/intracytoplasmic sperm injection cycles[J].Fertil Steril,2007,88:832-839.
[13]栾红兵,刘雨生,童先宏,等.控制性卵巢刺激方案及血清CA125水平对复发性卵巢子宫内膜异位囊肿患者体外受精-胚胎移植结局的影响[J].生殖医学杂志,2009,18:222-225.
[14]Bastu E,Yasa C,Dural O,et al.Comparison of ovulation induction protocols after endometrioma resection[J].JSLS,2014,18.e2014.00128.
[15]刘冬娥,张怡,李艳萍,等.改良超长降调节方案对卵巢子宫内膜异位囊肿手术后体外受精-胚胎移植结果的影响[J].实用妇产科杂志,2006,22:230-231.
[2]Verkauf BS.Incidence,symptoms,and signs of endometriosis in fertile and infertile women[J].J Fla Med Assoc,1987,74:671-675.
[3]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,2013,28:2140-2145.
[4]Filippi F,Benaglia L,Paffoni A,et al.Ovarian endometriomas and oocyte quality:insights from in vitro fertilization cycles[J].Fertil Steril,2014,101:988-993.
[5]Coccia ME,Rizzello F,Barone S,et al.Is there a critical endometrioma size associated with reduced ovarian responsiveness in assisted reproduction techniques?[J/OL].Reprod Biomed Online,2014,29:259-266.
[6]Somigliana E,Berlanda N,Benaglia L,et al.Surgical excision of endometriomas and ovarian reserve:a systematic review on serum antimullerian hormone level modifications[J].Fertil Steril,2012,98:1531-1538.
[7]Urman B,Alper E,Yakin K,et al.Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve[J/OL].Reprod Biomed Online,2013,27:212-216.
[8]Lee KH,Kim CH,Lee YJ,et al.Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma[J].Obstet Gynecol Sci,2014,57:297-303.
[9]Rickes D,Nickel I,Kropf S,et al.Increased pregnancy rates after ultralong postoperative therapy with gonadotropinreleasing hormone analogs in patients with endometriosis[J].Fertil Steril,2002,78:757-762.
[10]Sallam HN,Garcia-Velasco JA,Dias S,et al.Long-term pituitary down-regulation before in vitro fertilization(IVF)for women with endometriosis[DB/OL].Cochrane Database Syst Rev,2006,(1):CD004635.
[11]Kolanska K,Cohen J,Bendifallah S,et al.Pregnancy outcomes after controlled ovarian hyperstimulation in women with endometriosisassociated infertility:GnRH-agonist versus GnRH-antagonist[J].JGynecol Obstet Hum Reprod,2017,46:681-686.
[12]Pabuccu R,Onalan G,Kaya C.GnRH agonist and antagonist protocols for stage I-II endometriosis and endometrioma in in vitro fertilization/intracytoplasmic sperm injection cycles[J].Fertil Steril,2007,88:832-839.
[13]栾红兵,刘雨生,童先宏,等.控制性卵巢刺激方案及血清CA125水平对复发性卵巢子宫内膜异位囊肿患者体外受精-胚胎移植结局的影响[J].生殖医学杂志,2009,18:222-225.
[14]Bastu E,Yasa C,Dural O,et al.Comparison of ovulation induction protocols after endometrioma resection[J].JSLS,2014,18.e2014.00128.
[15]刘冬娥,张怡,李艳萍,等.改良超长降调节方案对卵巢子宫内膜异位囊肿手术后体外受精-胚胎移植结果的影响[J].实用妇产科杂志,2006,22:230-231.