回顾性分析卵巢反应不良患者不同促排卵方案的获卵结局及卵子发育情况

发布时间：2018-04-21 06:02

本文选题：控制性促排卵方案 + 获卵数　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:通过回顾性分析三种不同促排卵方案对卵巢反应不良不孕症患者再次控制性超促排卵治疗后的获卵结局及卵母细胞受精发育能力的差异,探究卵巢反应不良患者首选的促排卵治疗方案。方法:收集2014年01月-2016年03月既往体外受精-胚胎移植(IVF-ET)助孕治疗时发生卵巢反应不良且再次助孕治疗的不孕患者,共98个周期。记录入选患者的一般情况,包括月经期基础性激素水平。根据治疗时所采取促排卵方案的不同将所有入选周期分为三个组:黄体中期降调节长方案组30个周期、短方案组32个周期以及拮抗剂方案组36个周期。统计三组不同促排卵方案的促排卵天数(Gn天数)、促性腺素剂量(Gn剂量)、绒毛膜促性腺素注射日(HCG日)黄体生成素(LH)、雌激素(E2)、孕激素(P)水平、子宫内膜厚度(En)及获卵数、不同形态学分型卵母细胞数、卵母细胞受精数、正常受精数(2PN数)、不同级别卵裂期胚胎数、优质胚胎数。结果:1)各组不孕症患者的一般资料:年龄、不孕年限、窦卵泡数(AFC)、基础卵泡刺激素(FSH)间比较差异无统计学意义。2)对既往卵巢反应不良的促排卵周期,采用不同促排卵方案再次控制性超促排卵后,共23个周期出现卵巢低反应,包括拮抗剂方案组6个周期,发生率为16.7%,短方案组9个周期,发生率为28.1%,长方案组8个周期,发生率为26.6%。但三组间卵巢低反应发生率差异无统计学意义。且三组方案均无周期取消发生。3)排除卵巢低反应型卵巢反应不良周期,剩余75个卵巢反应不良周期中,Gn天数、Gn剂量三组间比较差异有统计学意义,长方案组显著较高。HCG日黄体生成素(LH)水平短方案组较长方案组和拮抗剂方案组显著增高(4.42±1.17 vs 1.31±1.22 vs 2.52±1.95),差异有统计学意义(P0.05)。4)短方案组获卵数显著高于长方案组(6.65±1.72 vs 5.18±1.36),差异有统计学意义。不同形态学卵母细胞成熟度分析,生发泡期(GV期)、第一次减数分裂期(MI期)、退化卵母细胞数三组间差异无统计学意义,短方案组第二次减数分裂期卵母细胞数(MII期)显著高于长方案组(5.52±1.53 vs 4.04±1.25)。但不同组间各期卵母细胞占总获卵数的比例差异无显著统计学意义。5)三组方案间卵母细胞受精数、2PN数、卵裂期胚胎数及优质胚胎数间差异有统计学意义,而拮抗剂方案组与短方案组间差异无统计学意义。长方案组受精率、优质胚胎率低于短方案和拮抗剂方案组,但2PN率和卵裂期胚胎率三组方案间差异无统计学意义。结论:1)长方案使卵巢反应不良患者发生卵巢低反应的概率增加。2)长方案的获卵数和MII期卵母细胞数低于短方案和拮抗剂方案,但各期卵母细胞占获卵数的比例三组方案间无差异。3)短方案和抗剂方案的卵母细胞受精数、正常受精数、胚胎数和优胚数高于长方案,且受精率和优胚率高于长方案。4)拮抗剂方案和短方案可作为卵巢反应不良患者促排卵治疗时首选方案,但短方案需密切监测LH水平。
[Abstract]:Objective: to retrospectively analyze the difference of oocyte outcome and oocyte fertilization development ability of three different ovulation promotion protocols in infertile patients with ovarian adverse reaction after controlled hyperstimulation of ovulation. To explore the first choice of ovulation promotion in patients with poor ovarian reaction. Methods: from January 2014 to March 2016, 98 cycles of infertile women with poor ovarian response and repeated assisted pregnancy therapy were collected. Record the general status of selected patients, including basal sex hormone levels during menstruation. All the selected cycles were divided into three groups according to the different ovulatory protocols used in the treatment: 30 cycles in the long luteal phase descending control group 32 cycles in the short regimen group and 36 cycles in the antagonist regimen group. The number of days of ovulation induction, gonadotropin (Gn), chorionic gonadotropin (HCG), the levels of luteinizing hormone (LHH), estrogen, progesterone (P), endometrial thickness (Eng) and the number of eggs obtained were analyzed in three groups. The number of oocytes of different morphologic credit types, the number of oocytes fertilized, the number of normal fertilization (2PN), the number of embryos at different cleavage stage, the number of high quality embryos. Results: there was no significant difference in age, age, length of infertility, number of antral follicles and FSHs of basal follicle stimulating hormone (FSHs). There were 23 cycles of ovarian hyporesponse, including 6 cycles in the antagonist group, 9 cycles in the short regimen group, and 8 cycles in the long regimen group, respectively, after repeated controlled hyperstimulation of ovulation with different ovulatory regimens, including 6 cycles in the antagonist regimen group with an incidence rate of 16.7 cycles, 9 cycles in the short regimen group and 28.1 cycles in the long regimen group. The incidence was 26.6%. However, there was no significant difference in the incidence of ovarian hyporesponse among the three groups. No cycle cancellations occurred. 3) ovarial low reactive ovarian adverse reaction cycles were excluded in all three groups. There was a significant difference among the three groups in the number of days of Gn and the dosage of Gn in the remaining 75 cycles of poor ovarian reaction. The level of LH in the long regimen group was significantly higher than that in the long regimen group and the antagonist regimen group. The number of eggs obtained in the short regimen group was significantly higher than that in the long regimen group and the antagonist regimen group (4.42 卤1.17 vs 1.31 卤1.22 vs 2.52 卤1.95). The number of eggs obtained in the short regimen group was significantly higher than that in the long regimen group (6.65 卤1.72 vs 5.18 卤1.36). The difference is statistically significant. There was no significant difference in the number of degenerated oocytes among the three groups, including GV stage, MI phase and degenerative oocyte number in the first meiosis stage, and there was no significant difference among the three groups in the maturation of different morphologic oocytes. The number of oocytes in the second meiosis phase in the short regimen group was significantly higher than that in the long regimen group (5.52 卤1.53 vs 4.04 卤1.25). However, there was no significant difference in the proportion of oocytes to the total number of oocytes among different groups. 5) the fertilization number of oocytes was 2PN, the number of embryos at cleavage stage and the number of high-quality embryos were significantly different among the three groups. However, there was no significant difference between the antagonist regimen group and the short regimen group. The fertilization rate and high quality embryo rate in the long regimen group were lower than those in the short and antagonist regimen groups, but there was no significant difference in 2PN rate and cleavage embryo rate among the three groups. Conclusion: 1) the probability of ovarian hyporesponse in patients with poor ovarian reaction increased by 1: 1) the number of oocytes obtained and the number of oocytes in MII phase of the long regimen were lower than those of short regimen and antagonist regimen. However, the proportion of oocytes in each stage in the three groups had no difference. 3) the number of oocytes fertilized, the number of normal fertilization, the number of embryos and the number of superior embryos were higher than those of the long scheme. The fertilization rate and embryo rate were higher than those of the long regimen. 4) antagonist regimen and short regimen could be the first choice for ovulation promotion in patients with poor ovarian reaction, but the LH level should be closely monitored by the short regimen.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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