卵巢储备功能减退的巧囊合并不孕的手术及辅助生殖治疗研究
发布时间：2019-02-23 20:54
【摘要】：目的：探讨卵巢子宫内膜异位囊肿(巧囊)伴储备功能下降行巧囊放液加囊壁电灼继以辅助生殖治疗的临床效果。 方法： 1.选取2010年2月至2013年6月因卵巢储备功能下降的巧囊合并不孕的患者42例为实验组,行腹腔镜下巧囊切开放液±囊壁电灼术,术后续以长方案或者超长方案促排卵行IVF/ICSI治疗；以2006年1月至2010年12月行腹腔镜下巧囊剥除术后行IVF/ICSI治疗的113例患者为对照组。 2.所有入选患者均记录基础情况,包括年龄、基础FSH、基础E2；促排卵情况,包括周期促性腺激素总量、获卵数、获卵率、受精率、胚胎数、优胚率和临床妊娠率。 3.比较不同侧别卵巢的反应差异和结局差异,如术前窦卵泡计数、术后窦卵泡计数,可穿刺卵泡数,获卵数,获卵率。 结果：(1)巧囊放液组平均年龄为31.1±3.6岁,对照组为31.6±3.7岁,两组比较无显著性差异；巧囊放液组基础FSH、基础E2为9.41±4.21IU/L和51.78±26.96ng/L,而对照组为7.86±2.58ng/L和43.42±21.28IU/L,两组比较有统计学差异(P0.05)。巧囊放液组周期获卵数、周期胚胎数以及周期促性腺激素总量为5.49±3.72个、3.30±2.52个及2855±765IU,对照组为6.80±4.62个、4.92±3.45个及2174±939IU,巧囊放液组患者周期促性腺激素总量增加,获卵数及胚胎数均较对照组低,两组比较具有统计学差异性(P0.05)；巧囊放液组获卵率、受精率及优胚率为65.41%,60.26%和42.37%,对照组为67.42%,64.65%和43.37%,两组比较差异无显著性(P0.05)；巧囊放液组起始周期临床妊娠率40%,对照组45.13%,两组比较差异无显著性(P0.05)。(2)不同侧别卵巢比较：巧囊切开放液可平均增加患侧卵巢窦卵泡计数0.49枚；初发巧囊行切开放液侧卵巢穿刺卵泡数及获卵数高于囊肿剥除侧；复发巧囊切开放液后可穿刺卵泡最少,该侧卵巢获卵数最少,但获卵率相当。 结论：术前巧囊切开放液+/-囊壁电灼治疗组较巧囊剥除组卵巢储备功能明显降低,但治疗后取得了与对照组无明显差异的获卵率、优胚率及临床妊娠率,表明巧囊放液+／-囊壁电灼继辅助生殖治疗是有效的,这样的术式可能改善了卵巢储备功能。
[Abstract]:Objective: to investigate the clinical effect of ovarial endometriosis cyst (OEC) with decline of reserve function. Methods: 1. From February 2010 to June 2013, 42 cases of cysts complicated with infertility due to the decline of ovarian reserve function were selected as experimental group. IVF/ICSI was used to induce ovulation with long or super long protocol. From January 2006 to December 2010, 113 patients with IVF/ICSI were treated by laparoscopic cystectomy. 2. All patients were enrolled to record basic information, including age, basal FSH, basal E2, ovulation promotion, including the total amount of cycle gonadotropin, the number of eggs acquired, the rate of egg acquisition, fertilization rate, number of embryos, the rate of superior embryo and the rate of clinical pregnancy. 3. The differences in response and outcome were compared, such as antral follicle count before operation, antral follicle count after operation, number of punctured follicles and oocyte yield. Results: (1) the average age was 31.1 卤3.6 years in the dexterous capsule group and 31.6 卤3.7 years in the control group. There was no significant difference between the two groups. The E _ 2 of basal FSH, was 9.41 卤4.21IU/L and 51.78 卤26.96ng / L in the dexterous capsule group, while that in the control group was 7.86 卤2.58ng/L and 43.42 卤21.28. There was significant difference between the two groups (P0.05). The number of eggs, the number of embryos and the total number of gonadotropins were 5.49 卤3.72, 3.30 卤2.52 and 2855 卤765IUs in the dexterous capsule group and 6.80 卤4.62, 4.92 卤3.45 and 2174 卤939IUs in the control group, respectively. The total amount of gonadotropin increased, the number of eggs and embryos were lower in the dexterous capsule group than in the control group, and there was statistical difference between the two groups (P0.05). The rate of obtaining eggs, fertilization rate and excellent embryo rate were 65.41% and 42.37% in the dexterous capsule group, 64.65% and 43.37% in the control group, respectively. There was no significant difference between the two groups (P0.05). The clinical pregnancy rate was 40% in the dexterous capsule group and 45.13% in the control group. There was no significant difference between the two groups (P0.05). (2). The average number of antral follicles in the affected side was increased by cystolithotomy and exfoliation (P0.05). (2). The number of punctured follicles and the number of oocytes obtained were higher in the first cleavage and exfoliation side than in the exfoliation side of the cyst, and the number of follicles could be punctured least after the recrudescent cleavage and opening fluid, and the oocyte number was the least in this side, but the rate of obtaining eggs was the same. Conclusion: the ovarian reserve function of the treatment group was significantly lower than that of the cleavage cystectomy group, but there was no significant difference between the treatment group and the control group in oocyte acquisition rate, embryo rate and clinical pregnancy rate. The results showed that the adjuvant reproductive therapy was effective, and the ovarian reserve function might be improved.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8
本文编号：2429189
[Abstract]:Objective: to investigate the clinical effect of ovarial endometriosis cyst (OEC) with decline of reserve function. Methods: 1. From February 2010 to June 2013, 42 cases of cysts complicated with infertility due to the decline of ovarian reserve function were selected as experimental group. IVF/ICSI was used to induce ovulation with long or super long protocol. From January 2006 to December 2010, 113 patients with IVF/ICSI were treated by laparoscopic cystectomy. 2. All patients were enrolled to record basic information, including age, basal FSH, basal E2, ovulation promotion, including the total amount of cycle gonadotropin, the number of eggs acquired, the rate of egg acquisition, fertilization rate, number of embryos, the rate of superior embryo and the rate of clinical pregnancy. 3. The differences in response and outcome were compared, such as antral follicle count before operation, antral follicle count after operation, number of punctured follicles and oocyte yield. Results: (1) the average age was 31.1 卤3.6 years in the dexterous capsule group and 31.6 卤3.7 years in the control group. There was no significant difference between the two groups. The E _ 2 of basal FSH, was 9.41 卤4.21IU/L and 51.78 卤26.96ng / L in the dexterous capsule group, while that in the control group was 7.86 卤2.58ng/L and 43.42 卤21.28. There was significant difference between the two groups (P0.05). The number of eggs, the number of embryos and the total number of gonadotropins were 5.49 卤3.72, 3.30 卤2.52 and 2855 卤765IUs in the dexterous capsule group and 6.80 卤4.62, 4.92 卤3.45 and 2174 卤939IUs in the control group, respectively. The total amount of gonadotropin increased, the number of eggs and embryos were lower in the dexterous capsule group than in the control group, and there was statistical difference between the two groups (P0.05). The rate of obtaining eggs, fertilization rate and excellent embryo rate were 65.41% and 42.37% in the dexterous capsule group, 64.65% and 43.37% in the control group, respectively. There was no significant difference between the two groups (P0.05). The clinical pregnancy rate was 40% in the dexterous capsule group and 45.13% in the control group. There was no significant difference between the two groups (P0.05). (2). The average number of antral follicles in the affected side was increased by cystolithotomy and exfoliation (P0.05). (2). The number of punctured follicles and the number of oocytes obtained were higher in the first cleavage and exfoliation side than in the exfoliation side of the cyst, and the number of follicles could be punctured least after the recrudescent cleavage and opening fluid, and the oocyte number was the least in this side, but the rate of obtaining eggs was the same. Conclusion: the ovarian reserve function of the treatment group was significantly lower than that of the cleavage cystectomy group, but there was no significant difference between the treatment group and the control group in oocyte acquisition rate, embryo rate and clinical pregnancy rate. The results showed that the adjuvant reproductive therapy was effective, and the ovarian reserve function might be improved.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8
【参考文献】
中国期刊全文数据库 前1条
1 马彩虹;乔杰;陈贵安;张英兰;杨池荪;;子宫内膜异位症合并不育中卵泡液肿瘤坏死因子-α的意义[J];中国妇产科临床杂志;2006年05期
，本文编号：2429189
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