黄体期促排卵方案在卵巢低反应及预期卵巢低反应患者中的临床应用

发布时间：2018-06-12 09:58

本文选题：体外受精-胚胎移植技术 + 辅助生殖技术　；参考：《滨州医学院》2014年硕士论文

【摘要】：目的：通过对黄体期促排卵方案与卵泡期促排卵方案及标准长方案在卵巢低反应及预期卵巢低反应患者中的应用比较,探讨黄体期促排卵方案在卵巢低反应及预期卵巢低反应患者中的临床应用。方法：回顾性分析199例采用微刺激促排卵方案的卵巢低反应及预期卵巢低反应患者,其中有31例患者既往于本中心行标准长方案促排卵治疗,助孕失败后再次接受黄体期促排卵治疗,有37例患者于卵泡期及黄体期均接受过促排卵治疗。上述患者共进行276个微刺激方案促排卵周期,其中包括123个黄体期促排卵周期,153个卵泡期促排卵周期。按照促排卵开始时间及促排卵方案进行如下分组：黄体期促排卵周期为A组,卵泡期促排卵周期为B组；标准长方案促排卵周期为C组,标准长方案助孕失败后采用黄体期促排卵方案的促排周期为D组；另外将37例于黄体期、卵泡期均行促排卵治疗的卵巢低反应患者,共97个取卵周期分为2组,黄体期促排卵周期为E组,卵泡期促排卵周期为F组。黄体期促排卵患者所获得的可移植胚胎行胚胎冷冻,择期行融胚助孕治疗；卵泡期促排卵患者根据患者胚胎移植日内膜情况及患者意愿,选择行新鲜胚胎或者冷冻胚胎。结果：1.A组均为获卵周期,至论文完成日共46例患者行冷冻胚胎移植,其中有9例临床妊娠,无生化妊娠流产；B组均为获卵周期,至论文完成日共28例患者行冷冻胚胎移植,其中有8例临床妊娠,2例生化妊娠流产。A组和B组患者窦卵泡数(antral follicle count, AFC)、基础内分泌比较后,除体重指数(body mass index, BMI)组间差异有统计学意义外,余指标(包括年龄、不孕年限、AFC、基础内分泌、FSH/LH)差异均无统计学意义(P0.05)。A组患者尿促性素(human menopausal gonadotropin, HMG)用量、促排卵天数均较B组患者高,组间差异有统计学意义(P0.05)；A组患者受精率均较B组患者高,组间差异有统计学意义(P0.05),两组患者获卵数、卵裂率、优胚率、融胚周期妊娠率差异无统计学意义(P0.05),尽管A、B两组的优胚率无统计学差异,但A组患者优胚率较B组患者有增高的趋势。2.两组患者年龄、不孕年限、BMI、AFC、基础内分泌、FSH/LH差异均无统计学意义(P0.05)。D组周期取消率较C组低,受精率较C组高,组间差异有统计学意义(P0.05)。D组卵裂率、优胚率、融胚周期妊娠率较C组有增高趋势,但两组差异无统计学意义(P0.05)。3.E组均为获卵周期,至论文完成日共14例患者行冷冻胚胎移植,其中有2例临床妊娠,无生化妊娠流产；F组均为获卵周期,至论文完成日共13例患者行冷冻胚胎移植,其中有3例临床妊娠,无生化妊娠流产。两组患者年龄、不孕年限、BMI、AFC、基础内分泌、FSH/LH差异均无统计学意义(P0.05)；E组HMG用量及促排卵天数较F组高,组间差异有统计学意义(P0.05)；E组获卵数、受精率、卵裂率、优胚率、融胚移植周期临床妊娠率与F组比较,各指标间差异均无统计学意义(P0.05),但前者优胚率及临床妊娠率较后者有升高趋势。结论：1.黄体期促排卵方案及卵泡期促排卵方案均可用于卵巢低反应及预期卵巢低反应患者的助孕治疗。2.黄体期促排卵方案能获得更好的受精率和优质胚胎。3.与标准长方案比较,黄体期促排卵方案可降低卵巢低反应及预期卵巢低反应患者的周期取消率,并提高受精率,以达到妊娠的目的。4.黄体期促排卵方案可改善卵巢低反应患者的胚胎质量及临床结局。
[Abstract]:Objective : To investigate the clinical application of ovulation - induced ovulation ( LH ) in low - reactive ovarian response and low - reactive ovarian response in patients with low ovarian response and expected low ovarian response . Methods : A retrospective analysis of 199 patients with low ovarian response and low - expected ovarian response in ovarian low - response patients was performed .
The ovulation cycle of the standard long scheme is group C , and the ovulation period of the standard long scheme is D group after the failure of the standard long scheme .
In addition , 37 patients with low ovarian response were treated with ovulation induction in the corpus luteum and the follicular phase . The period of ovulation induction was divided into 2 groups , the period of ovulation induction in the corpus luteum was E group , and the period of ovulation induction was F group .
Results : 1 . In group A , there were 46 cases of frozen embryo transfer , including 9 cases of clinical pregnancy and no biochemical pregnancy induced abortion .
There were 8 cases of clinical pregnancy and 2 cases of biochemical pregnancy induced abortion . There was no significant difference between body mass index ( AFC ) and body mass index ( BMI ) in group A and group B ( P0.05 ) .
There was no statistical difference between group A and group B ( P0.05 ) . There was no statistical difference between the two groups ( P0.05 ) .
There were 3 cases of clinical pregnancy and no biochemical pregnancy induced abortion . There were no significant differences in age , age , BMI , AFC , basal endocrine and FSH / LH in both groups ( P0.05 ) .
The dosage of HMG and the number of days of ovulation were higher in group E than in group F ( P0.05 ) .
Conclusion : 1 . The scheme of ovulation and ovulation in the corpus luteum can decrease the cycle elimination rate of the patients with low ovarian response and lower expected ovarian response , and improve the fertilization rate to achieve the purpose of pregnancy .
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

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