三種控制性超促排卵方案在高齡婦女體外受精-胚胎移植中的療效分析_《華西醫學》

作者：

魏晗 ,  李尚為 , 曾珣 , 李小紅 , 李曉詩

四川大學華西第二醫院生殖中心（成都，610041）;

關鍵詞：

體外受精-胚胎移植控制性超促排卵促性腺激素釋放激素拮抗劑促性腺激素釋放激素激動劑

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目的　探討3種不同助孕方案在≥40歲婦女體外受精-胚胎移植（IVF-ET）周期中的臨床效果。方法　回顧性分析2010年8月－2012年2月期間，于四川大學華西第二醫院生殖中心行IVF-ET助孕、年齡≥40歲婦女共245個周期的臨床資料，排除一側卵巢缺如患者3例，余242個周期根據助孕方案不同分為3組：拮抗劑組（GnRH-A方案組）44個周期、長方案組109個周期及短方案組89個周期，比較3種方式助孕的臨床效果。結果　3組均無早發黃體生成素峰；長方案組應用促性腺激素（Gn）的時間最長，應用Gn數量最多，獲得最高的獲卵數及獲胚數（P＜0.05）；3組的受精率、優胚率、冷凍胚胎數、周期取消率、卵巢過度刺激綜合征發生率、早期流產率均無統計學意義（P＞0.05），短方案組的種植率及臨床妊娠率最低（P＜0.05）。結論　GnRH-a長方案在≥40歲婦女的IVF-ET周期中具有較好的臨床結局，在≥40歲婦女IVF-ET周期中具有與長方案相似的結局，并且可以減少Gn使用量，提高卵泡及胚胎質量，短方案組對≥40歲婦女臨床效果較差。

引用本文： 魏晗,李尚為,曾珣,李小紅,李曉詩. 三種控制性超促排卵方案在高齡婦女體外受精-胚胎移植中的療效分析. 華西醫學, 2012, 27(12): 1855-1858. doi: 復制

1.	Tsafrir A, Simon A, Margalioth EJ, et al. What should be the first-line treatment for unexplained infertility in women over 40 years of age ovulation induction and IUI, or IVF[J]. Reproductive Bio Medicine Online，2009, 19(Suppl 4): 47-56.
2.	肖勁松, 陳雙隕, 張春蓮, 等. 促性腺激素釋放激素拮抗劑在體外受精-胚胎移植中有效性的系統性評價[J]. 中國循證醫學雜志, 2010, 10(12): 1432-1438.
3.	肖勁松, 陳雙隕, 張春蓮, 等. GnRH-拮抗劑對體外受精-胚胎移植中低反應患者有效性的系統性評價現代婦產科進展[J]. 現代婦產科進展, 2011, 20(4): 300-306.
4.	Veek LL. The morphological assessment of human oocytes and early concpti. In: Keel BA , Webster BW editors.Hand-book of the Laboratory Diagnosis and Treatment of Infertility[C]. Boca Raton FL: CRC Press, 1990: 353-369.
5.	何鉆玉, 李琳, 陳曉莉, 等. 不同年齡段不孕患者控制性超排卵中卵巢低反應的預測[J]. 中國婦產科臨床雜志, 2011, 12(6): 410-413.
6.	Serour G, Mansour R, Serour A, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above[J]. Fertil Steril, 2010, 94(5): 1707-1712.
7.	Klipstein S, Regan M, Ryley DA, et al. One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above[J]. Fertil Steril, 2005, 84(2): 435-445.
8.	Ng EH, Ho PC. Ageing and ART: a waste of time and money?[J]. Best Pract Res Clin Obstet Gynaecol, 2007, 21(1): 5-20.
9.	Tsafrir A, Simon A, Revel A, et al. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older[J]. Reproductive BioMedicine Online, 2007,14(3): 348-355.
10.	Avrech OM, Orvieto R, Pinkas H, et al. Inclusion of standard and low-dose gonadotropin releasing hormone-analog (short protocol) in controlled ovarian hyperstimulation regimens in normogonadotropic patients aged 40-48 years who are undergoing in vitro fertilization[J]. Gynecol Endocrinol, 2004, 19(5): 247-252.
11.	王樂樂, 陳士嶺, 陳薪, 等. 高齡婦女體外受精-胚胎移植治療周期的臨床特征和治療結局分析[J]. 中國優生與遺傳雜志, 2011, 19(5): 105-107.
12.	Huirne JA, van Loenen AC, Schats R, et al. Dose-finding study of daily gonadotropin-releasing hormone (GnRH) antagonist for the prevention of premature luteinizing hormone surges in IVF/ICSI patients: antide and hormone levels[J]. Hum Reprod, 2004, 19(10): 2206-2215.
13.	Sbracia M, Colabianchi J, Giallonardo A, et al. Cetrorelix protocol versus gonadotropin-releasing hormone analog suppression long protocol for superovulation in intracytoplasmic sperm injection patients older than 40[J]. Fertility and Sterility, 2009, 91(5): 1842-1847.
14.	Lubna Pal, Sangita J, Barry R, et al. Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization[J]. Fertility and Sterility, 2008, 89(6): 1694-1701.
15.	Amir W, Micha B, Ariel H, et al. Predicting factors for endometrial thickness during treatment with assisted reproductive technology[J]. Fertility and Sterility, 2007, 87(4): 799-804.

1. 　Tsafrir A, Simon A, Margalioth EJ, et al. What should be the first-line treatment for unexplained infertility in women over 40 years of age ovulation induction and IUI, or IVF[J]. Reproductive Bio Medicine Online，2009, 19(Suppl 4): 47-56.
2. 　肖勁松, 陳雙隕, 張春蓮, 等. 促性腺激素釋放激素拮抗劑在體外受精-胚胎移植中有效性的系統性評價[J]. 中國循證醫學雜志, 2010, 10(12): 1432-1438.
3. 　肖勁松, 陳雙隕, 張春蓮, 等. GnRH-拮抗劑對體外受精-胚胎移植中低反應患者有效性的系統性評價現代婦產科進展[J]. 現代婦產科進展, 2011, 20(4): 300-306.
4. 　Veek LL. The morphological assessment of human oocytes and early concpti. In: Keel BA , Webster BW editors.Hand-book of the Laboratory Diagnosis and Treatment of Infertility[C]. Boca Raton FL: CRC Press, 1990: 353-369.
5. 　何鉆玉, 李琳, 陳曉莉, 等. 不同年齡段不孕患者控制性超排卵中卵巢低反應的預測[J]. 中國婦產科臨床雜志, 2011, 12(6): 410-413.
6. 　Serour G, Mansour R, Serour A, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above[J]. Fertil Steril, 2010, 94(5): 1707-1712.
7. 　Klipstein S, Regan M, Ryley DA, et al. One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above[J]. Fertil Steril, 2005, 84(2): 435-445.
8. 　Ng EH, Ho PC. Ageing and ART: a waste of time and money?[J]. Best Pract Res Clin Obstet Gynaecol, 2007, 21(1): 5-20.
9. 　Tsafrir A, Simon A, Revel A, et al. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older[J]. Reproductive BioMedicine Online, 2007,14(3): 348-355.
10. 　Avrech OM, Orvieto R, Pinkas H, et al. Inclusion of standard and low-dose gonadotropin releasing hormone-analog (short protocol) in controlled ovarian hyperstimulation regimens in normogonadotropic patients aged 40-48 years who are undergoing in vitro fertilization[J]. Gynecol Endocrinol, 2004, 19(5): 247-252.
11. 　王樂樂, 陳士嶺, 陳薪, 等. 高齡婦女體外受精-胚胎移植治療周期的臨床特征和治療結局分析[J]. 中國優生與遺傳雜志, 2011, 19(5): 105-107.
12. 　Huirne JA, van Loenen AC, Schats R, et al. Dose-finding study of daily gonadotropin-releasing hormone (GnRH) antagonist for the prevention of premature luteinizing hormone surges in IVF/ICSI patients: antide and hormone levels[J]. Hum Reprod, 2004, 19(10): 2206-2215.
13. 　Sbracia M, Colabianchi J, Giallonardo A, et al. Cetrorelix protocol versus gonadotropin-releasing hormone analog suppression long protocol for superovulation in intracytoplasmic sperm injection patients older than 40[J]. Fertility and Sterility, 2009, 91(5): 1842-1847.
14. 　Lubna Pal, Sangita J, Barry R, et al. Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization[J]. Fertility and Sterility, 2008, 89(6): 1694-1701.
15. 　Amir W, Micha B, Ariel H, et al. Predicting factors for endometrial thickness during treatment with assisted reproductive technology[J]. Fertility and Sterility, 2007, 87(4): 799-804.

《華西醫學》

三種控制性超促排卵方案在高齡婦女體外受精-胚胎移植中的療效分析

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《華西醫學》

三種控制性超促排卵方案在高齡婦女體外受精-胚胎移植中的療效分析

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