李元，龚斐，2*

(1. 中南大学生殖与干细胞研究所，长沙　410008；2. 中信湘雅生殖与遗传专科医院，长沙　410008)



改良超长方案在卵巢低反应患者促排卵治疗中的应用

李元1，龚斐1，2*

(1. 中南大学生殖与干细胞研究所，长沙410008；2. 中信湘雅生殖与遗传专科医院，长沙410008)

目的探讨卵巢低反应(POR)患者在体外受精-胚胎移植(IVF-ET)/卵胞浆内单精子注射(ICSI)助孕治疗过程中行改良超长方案和灵活拮抗剂方案对其妊娠结局的影响。方法回顾性分析2013年1月1日至2013年12月31日在本院生殖中心接受IVF/ICSI助孕治疗的515例POR患者的临床资料，根据促排卵方案不同分为改良超长方案组(A组，n=137)和拮抗剂方案组(B组，n=378)。比较两组患者卵巢刺激天数(Gn天数)、Gn用量、HCG日激素水平、子宫内膜情况、平均获卵率、优胚率、受精率、着床率、临床妊娠率、移植周期取消率、流产率及宫外孕发生率等。结果与拮抗剂方案组比较，改良超长方案组的Gn天数[(12.42±2.80) vs.(8.53±2.54) d]、Gn用量[(4 447.81±2 804.28) vs.(1 916.67±622.62) U]、HCG日子宫内膜厚度[(12.15±2.66) vs.(10.53±2.31) mm]、平均获卵数[(2.97±1.50) vs.(2.43±1.52)个]均显著增加(P均<0.01)，HCG日孕酮(P)水平[(0.46±0.27) vs.(0.56±0.26) nmol/L]、早发LH峰发生率(0 vs. 12.96%)、优胚率[(51.19±41.17)% vs.(63.72±38.74)%]、周期取消率(41.61% vs. 53.17%)显著下降(P均<0.05)。改良超长方案组的着床率(33.99% vs. 15.15%)、临床妊娠率(48.75% vs. 26.55%)显著高于拮抗剂方案组(P均<0.01)。两组的流产率和宫外孕发生率比较无显著性差异(P>0.05)。结论POR患者行促排卵治疗时，选择改良超长方案可能更有利于改善IVF/ICSI-ET结局，但药物使用成本相对较高。

改良超长方案；拮抗剂方案；卵巢低反应；体外受精；胚胎移植

【Abstract】

Objective： To compare IVF outcomes between modified supper long protocol and flexible antagonist protocol in women of poor ovarian response (POR).

Methods： The clinical data of 515 POR patients undergone IVF/ICSI in our center from Jan. 2013 to Dec. 2013 were retrospectively analyzed. The patients were divided to two groups according to different protocol of ovulation induction： group A with modified supper long protocol (n=137) and group B with flexible antagonist protocol (n=378). The gonadotropin (Gn) duration and dosage，reproductive hormone levels and endometrial thickness on HCG day，number of oocytes retrieved，high-quality embryo rate，fertilization rate，implantation rate，clinical pregnancy rate，cycle cancellation rate，spontaneous abortion rate and ectopic pregnancy rate were compared between the two groups.

Results： The Gn dosage [(4 447.81±2 804.28) vs.(1 916.67±622.62) U] and duration [(12.42±2.80) vs.(8.53±2.54) days)]，endometrial thickness on HCG day [(12.15±2.66) vs.(10.53±2.31) mm]，and number of oocytes retrieved [(2.97±1.50) vs.(2.43±1.52)] were significantly increased (allP<0.01)，while progesterone levels on HCG day [(0.46±0.27) vs.(0.56±0.26) nmol/L] and the premature LH surge rate (0% vs. 12.96%)，high-quality embryo rate [(51.19±41.17)% vs.(63.72±38.74)%]，cycle cancellation rate (41.61% vs. 53.17%) were significantly decreased(allP<0.05)in group A compared with group B. The implantation rate (33.99% vs. 15.15%) and pregnancy rate (48.75% vs. 26.55%) in group A were significantly higher than those in group B (allP<0.01). There were no significant differences in abortion rate and ectopic pregnancy rate between the two group(P>0.05).

Conclusions： The modified supper long protocol can improve the pregnant outcome compared with the flexible antagonist protocol in IVF/ICSI for the poor ovarian responders，but the cost of drug usage is relatively high.

(JReprodMed2016，25(8)：681-685)

随着辅助生殖技术(ART)的日益发展和成熟，目前体外受精-胚胎移植(IVF-ET)助孕治疗的临床妊娠率稳步上升，但超排卵过程中卵巢低反应(POR)的发生率仍有5.6%～35.1%[1]。POR是指助孕治疗过程中卵巢对外源性促性腺激素(Gn)刺激反应不佳的一种病理状态，促排卵周期中Gn用量增加、回收卵数目减少及临床妊娠率降低等是POR患者的主要特点。……