高彦，冒韵东，王 媁，黄洁，钱晓乔，刁飞扬，刘嘉茵

(南京医科大学第一附属医院生殖医学科，南京　210029)



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

高彦，冒韵东，王 媁，黄洁，钱晓乔，刁飞扬*，刘嘉茵*

(南京医科大学第一附属医院生殖医学科，南京210029)

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<8 mm，FSH<16 U/L、E2<280 pmol/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>15 mm，平均每个优势卵泡E2约等于1 100 pmol/L时，于当天20：30肌肉注射0.1 mg GnRH激动剂(GnRH-a)诱发排卵，34～36 h后取卵。在内膜达8～14 mm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。

卵巢功能减退；自然周期；克罗米芬；微刺激

Methods：The data of 6 632 poor ovarian responders were extracted from CCRM database of the reproductive center. Among the patients，there were 2 253 patients with nature cycles and 4 379 patients with minimal stimulation protocol. The number and diameter of antral follicles，and the basal levels of FSH，LH and E2were monitored on day 3 of menstrual cycle. The patients with antral follicle diameter <8 mm，FSH<16 U/L and E2<280 pmol/L took clomiphene citrate and/or HMG minimal stimulation protocol；otherwise，the patients took natural cycle. When the follicular diameter was>15 mm and E2levels per dominant follicle were about 1 100 pmol/L，the patients received 0.1 mg GnRH agonist injection at 20：30 to induce ovulation. The oocytes were picked-up 34-36 hours after trigger. The fresh embryo transfer was performed when endometrial thickness reached 8-14 mm；otherwise，the vitrificated embryos were transferred in the next cycle.

Results：The pregnancy rate per transfer cycle was about 30% in poor ovarian responder with natural cycle or minimal stimulation protocol. The pregnancy rate is not significantly changed along with increased number of cycles. The cumulative pregnancy rate was about 46% after 4 cycles.

Conclusions：The pregnancy rate is not decreased along with increased number of cycles in the natural cycle or minimal stimulation protocol cycle. It is recommend to continuous use of natural cycle or micro-stimulation treatment for poor ovarian responder，which can save treatment time and improve cumulative pregnancy rate.

(JReprodMed2016，25(10)：897-900)

许多女性因为年龄、手术、放化疗、遗传和环境等各种因素出现卵巢功能减退，有时患者在相关检查中虽然没有发现明显的卵巢功能减退迹象，但使用常规的促排卵治疗后表现为卵巢低反应，无法获得希望的卵母细胞数目，更无法达到预期的妊娠结果[1-2]。虽……