[1]李亨利,田东梅,朱明辉*,等.标准长方案超促排卵不同卵巢反应的相关分析[J].中国计划生育和妇产科,2017,(12):5- 8,17.
　LI Heng-li,TIAN Dong-mei,ZHU Ming-hui*,et al.Correlation analysis of different ovarian responses to standard long protocol controlled ovarian hyperstimulation[J].Chinese Journal of Family Planning & Gynecotokology,2017,(12):5- 8,17.
点击复制

标准长方案超促排卵不同卵巢反应的相关分析
分享到：

《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2017年12期
页码:
5- 8,17
栏目:
论著与临床
出版日期:
2017-12-25

文章信息/Info

Title:
Correlation analysis of different ovarian responses to standard long protocol controlled ovarian hyperstimulation
作者:
李亨利; 田东梅; 朱明辉*; 庄静; 刘泓伶
成都中医药大学第二附属医院生殖医学中心
Author(s):
LI Heng-li;  TIAN Dong-mei ;  ZHU Ming-hui*; ZHUANG Jing;  LIU Hong-ling
Reproductive Medical Center, The Second Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan 610041,P.R.China
关键词:
控制性超促排卵; 体外受精-胚胎移植; 卵胞质内单精子显微注射; 卵巢储备; 卵巢反应
Keywords:
controlledovarian hyperstimulation ; in vitro fertilization-embryo transfer;  intracytoplasmic sperm injection;  hCG-day;  ovarian reserve;  ovarian response
分类号:
R 7137
摘要:
目的对标准长方案控制性超促排卵(controlled ovarian hyperstimulation,COH)过程中出现的不同卵巢反应进行相关分析，评价卵巢储备相关指标变化。方法选取成都中医药大学第二附属医院生殖医学中心2013～2014年收治的卵巢储备评估正常的不孕患者，在行标准长方案体外受精-胚胎移植或卵母细胞质内单精子显微注射治疗的304例，依据取卵日获卵数水平分成3组：L组(低反应组，41例)，获卵数≤4个；N组(正常反应组，226例)，5个≤获卵数≤14个；H组(高反应组，37例)，获卵数≥15个。回顾性分析比较各组临床资料、治疗经过及妊娠结局。结果H组基础卵泡刺激素（basic follicle-stimulating hormone，bFSH）低于N组,L组bFSH/基础黄体生成素（basic luteal hormone，bLH）高于N组。治疗经过及结局：3组间促性腺激素使用总量、使用天数以及人绒毛膜促性腺激素注射日LH、雌二醇（estradiol，E2）、孕酮(progesterone,P)两两比较差异无统计学意义(P>005)。L组E2/P小于N组，优胚率高于N组；H组周期取消率大于N组，差异均有统计学意义(P<005)。获卵数、成熟卵数、2 PN数、优胚数两两比较差异有统计学意义(P<005)，且随着获卵数增多，成熟卵数、2 PN数、优胚数均增高。鲜胚移植临床妊娠率、流产率各组比较差异无统计学意义(P>005)。结论评估7≤基础窦卵泡数≤13的标准长方案COH时，当bFSH>7 mIU/mL、FSH/LH比值 >184时有出现卵巢低反应倾向；而bFSH<579 mIU/mL、FSH/LH比值 <148时更易发生卵巢高反应。COH中联合应用多个指标评估卵巢储备功能，对预测卵巢发生非预期异常反应，提高其预测效能具有一定的临床价值。
Abstract:
ObjectiveTo conduct correlation analysis on different ovarian responses among patients to standard long protocol controlled ovarian hyperstimulation(COH). MethodsRetrospectively analyzed a total of 304 long protocol IVF/ICSI-ET treatment cycles at The Second Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2013 to December 2014 on patients aged between 25 and 35 with normal ovarian reserve. According to the number of retrieved oocytes on the day of hCG trigger, the patients were divided into 3 groups- group L (poor ovarian response,n=41): the number of retrieved oocytes≤4; group N(normal ovarian response, n=226):5≤the number of retrieved oocytes≤14;and group H(high ovarian response, n=37):the number of retrieved oocytes≥15. Basic clinic data, treatment and pregnancy outcomes were compared among the groups. ResultsThe basic follicle-stimulating hormone (Bfsh) value of group H was significantly lower than that of group N. The value of Bfsh/ basic luteal hormone(bLH) of group L was significantly higher than that of group N(P<005). Treatment and pregnancy outcomes: There were no significant differences among the 3 groups in the application amount of gonadotropin(Gn), the Gn application hours or the values of LH, estradiol(E2) and progesterone(P） on the day of hCG injection. The E2/P value of group L was significantly lower than that of group N(P<005). As the number of retrieved oocytes increased, the number of mature oocytes, the diploid number of fertilizations(2PN) and the number of high quality embryos increased(P<005). The rate of high quality embryos of group L was significantly higher than that of group N.The rate of cycle cancellation of group H was significantly higher than that of group N(P<005).The rate of clinic pregnancy of fresh embryo transfer and the abortion rate are statistically insignificant(P>005).ConclusionEstimating long protocol in COH with 7≤AFC≤13, when bFSH>7mIU/mL and FSH/LH>184,a low ovarian response tends to occur; when bFSH<579mIU/ml and FSH/LH<148,a high ovarian reaction is more likely to occur. Combining multiple indicators for assessing the ovarian reserve in COH can enable the forecast of unexpected abnormal ovary reactions and improve the forecasting efficacy.

参考文献/References:

［1］胡琳莉，孙莹璞．卵泡发育调控与促排卵 ［J］．中国实用妇科与产科杂志，2015，31（1）：18-21． ［2］李力，乔杰．实用生殖医学 ［M］．北京：人民卫生出版社，2012． ［3］沈妮，刘雨生．体外受精-胚胎移植超促排卵中的卵巢低反应 ［J］．国际生殖健康/计划生育杂志，2009，28（5）：309-312． ［4］FERRANRETTI A P, LA MARCA A, FAUSTER B C, et al. ESHRE working group on poor ovarian respone definition ［J］. ESHRE consensus on the definition of'poor response'to ovarian stimulation for in vitro fertilization:the Bologna criteria.Hum Reprod, 2011, 26 (7)： 1616-1624. ［5］武学清，孔蕊，田莉，等．卵巢低反应专家共识 ［J］．生殖与避孕，2015，35（2）：71-79． ［6］NELSON S M. Biomarkers of ovarian response: current and future applications ［J］. Fertility and Sterility, 2013, 99 (4)： 963-969. ［7］何于夏，夏容，陈薪，等．在体外受精-胚胎移植中应用多项卵巢储备功能评估指标预测卵巢反应性 ［J］．南方医科大学学报，2013，33（2）：216-220． ［8］张秀萍．卵巢储备功能的预测指标的临床价值 ［D］．太原：山西医科大学，2014． ［9］VURAL B, CAKIROGLU Y, VURAL F, et al. Hormonal and functional biomarkers in ovarian response ［J］. Archives of Gynecology and Obstetrics, 2014, 289 (6)： 1355-1361. ［10］牛志宏，夏兰，王瑶．基础血清卵泡刺激素/黄体生成素比值评估卵巢反应性价值的探讨 ［J］．生殖医学杂志，2006，15（5）：297-300．

相似文献/References:

[1]吴小明,李强.体外受精与胚胎移植前输卵管积水处理方式的探讨[J].中国计划生育和妇产科,2009,(06):0.
[2]方伟芬,孙燕萍,牛向丽,等.体外受精后不同时期观察受精对胚胎质量的影响[J].中国计划生育和妇产科,2010,(01):0.
　FANG Wei-fen,SUN Yan-ping,NIU Xiang-li,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2010,(12):0.
[3]黄卡立,公方强,檀大羡,等.应用微刺激联合拮抗剂方案对76例卵巢低反应者进行体外受精-胚胎移植的临床研究[J].中国计划生育和妇产科,2010,(01):0.
　HUANG Ka-li,GONG Fang-qiang,TAN Da-xianResearch centre of population and family planning of Guangxi Zhuang Autonomous Region,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2010,(12):0.
[4]陈颖,扎西,李瑞文,等.垂体降调节后促性腺激素启动日两种雌二醇水平与体外受精-胚胎移植结局的关系[J].中国计划生育和妇产科,2010,(02):0.
　CHEN Ying,ZHA Xi,LI Rui-wen,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2010,(12):0.
[5]黄卡立,檀大羡.3种黄体支持方法在体外受精-胚胎移植术后对妊娠结局的影响[J].中国计划生育和妇产科,2010,(03):0.
　HUANG Ka-Li,TAN Da-xian.[J].Chinese Journal of Family Planning & Gynecotokology,2010,(12):0.
[6]李艳梅,李梦洁,柳雪琴,等.体外受精-胚胎移植患者的心理问题及其护理研究[J].中国计划生育和妇产科,2010,(03):0.
[7]孙燕萍,牛向丽,陈自洪,等.玻璃化与程序化两种不同胚胎冻融方法的临床应用效果比较[J].中国计划生育和妇产科,2011,(01):0.
　SUN Yan-ping,NIU Xiang-li,CHEN Zi-hong,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2011,(12):0.
[8]梁雪飞,檀大羡,王书佳,等.长方案注射HCG日血清雌二醇/孕酮比值对体外受精-胚胎移植结局的影响[J].中国计划生育和妇产科,2011,(03):0.
　LIANG Xue-fei,TAN Da-xian,WANG Shu-jia.[J].Chinese Journal of Family Planning & Gynecotokology,2011,(12):0.
[9]周晓燕,刘雨生,骆丽华,等.超排卵长方案中长效与短效促性腺激素激动剂降调节效果比较[J].中国计划生育和妇产科,2011,(03):0.
[10]刘晓妍,张守信,沈肖方,等.缩短挽救性ICSI卵龄有助于改善完全受精失败周期的结局[J].中国计划生育和妇产科,2012,(02):0.
　LIU Xiao-yan,ZHANG Shou-xin,SHEN Xiao-fang,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2012,(12):0.
[11]赵振钏*,亓蓉,吴小华,等.卵巢刺激慢反应患者补充生长激素的疗效评价[J].中国计划生育和妇产科,2019,(7):41.
　ZHAO Zhen-chuan*,QI Rong,WU Xiao-hua,et al.Efficacy evaluation of supplementation of growth hormone in patients with suboptimal ovarian response[J].Chinese Journal of Family Planning & Gynecotokology,2019,(12):41.

备注/Memo

备注/Memo:
成都市科技局科技惠民项目（项目编号：2014-HM01-00247-SF）
更新日期/Last Update: 2017-12-25