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

发布时间：2018-06-20 01:26

本文选题：卵巢功能减退 + 自然周期　；参考：《生殖医学杂志》2016年10期

【摘要】：目的探讨卵巢功能减退患者,采用自然周期或微刺激周期体外受精(IVF)/卵胞浆内单精子注射(ICSI)治疗的临床参数(获卵率、受精率、妊娠率),为临床治疗提供依据。方法从本生殖中心CCRM数据库中选取6 632例卵巢功能减退患者的临床资料,其中自然周期2 253例,微刺激周期4 379例,在月经第3天B超监测窦卵泡数目、直径,检查基础FSH、LH、E2值。窦卵泡直径8mm,FSH16U/L、E2280pmol/L的患者,采用克罗米芬/加HMG微刺激促排卵,否则行自然周期。当优势卵泡直径15mm,平均每个优势卵泡E2约等于1 100pmol/L时,于当天20:30肌肉注射0.1mg GnRH激动剂(GnRH-a)诱发排卵,34~36h后取卵。在内膜达8~14mm时行新鲜胚胎移植,否则行胚胎的玻璃化冷冻,待以后行自然周期移植。结果自然周期或微刺激IVF/ICSI治疗时,卵巢功能减退患者的每移植周期妊娠率为30%左右,随着治疗次数的增加,妊娠率没有明显改变,连续4周期累计妊娠率约46%。结论卵巢功能减退患者在自然周期/微刺激治疗中,妊娠率没有随着治疗次数的增加而下降,建议连续采用自然周期/微刺激治疗,节约治疗时间、提高累积妊娠率。年龄45岁的不孕症患者应适时终止自然周期/微刺激治疗,或改用供卵IVF治疗。
[Abstract]:Objective to investigate the clinical parameters (oocyte acquisition rate, fertilization rate and pregnancy rate) in patients with ovarian dysfunction treated by IVFFU / ICSI during natural or microstimulation cycles, and to provide evidence for clinical treatment. Methods the clinical data of 6 632 patients with ovarian dysfunction were selected from CCRM database of the reproductive center, including 2 253 cases of natural cycle and 4 379 cases of microstimulation cycle. The number and diameter of antral follicles were monitored by B ultrasound on the 3rd day of menstruation. Patients with antral follicle diameter of 8mm FSH 16U / L FSH / L 2280pmol / L were treated with clomiphene / HMG microstimulation to induce ovulation, otherwise, natural cycles were performed. When the diameter of dominant follicle was 15mm and the average E _ 2 of each dominant follicle was about 1 100pmol / L, the ovulation was induced by intramuscular injection of 0.1mg GnRH agonist GnRH-a at 20:30 on the same day for 3436 hours. Fresh embryo transfer was performed at endodal 8~14mm, otherwise vitrification of embryo was performed, and then natural cycle transfer was performed. Results during the treatment of IVF / ICSI, the pregnancy rate of the patients with ovarian dysfunction was about 30% per transplant cycle. With the increase of treatment times, the pregnancy rate did not change significantly, and the cumulative pregnancy rate for 4 consecutive cycles was about 46.1%. Conclusion the pregnancy rate does not decrease with the increase of treatment times in patients with ovarian dysfunction. It is suggested that the treatment of natural cycle / microstimulation should be used continuously to save the treatment time and increase the cumulative pregnancy rate. 45-year-old infertility patients should terminate the natural cycle / microstimulation therapy or switch to IVF therapy.
【作者单位】：南京医科大学第一附属医院生殖医学科;
【基金】：江苏省妇幼保健重点人才FRC201307
【分类号】：R714.8

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