本文選題：控制性促排卵方案 + 獲卵數(shù)　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過回顧性分析三種不同促排卵方案對卵巢反應(yīng)不良不孕癥患者再次控制性超促排卵治療后的獲卵結(jié)局及卵母細胞受精發(fā)育能力的差異,探究卵巢反應(yīng)不良患者首選的促排卵治療方案。方法:收集2014年01月-2016年03月既往體外受精-胚胎移植(IVF-ET)助孕治療時發(fā)生卵巢反應(yīng)不良且再次助孕治療的不孕患者,共98個周期。記錄入選患者的一般情況,包括月經(jīng)期基礎(chǔ)性激素水平。根據(jù)治療時所采取促排卵方案的不同將所有入選周期分為三個組:黃體中期降調(diào)節(jié)長方案組30個周期、短方案組32個周期以及拮抗劑方案組36個周期。統(tǒng)計三組不同促排卵方案的促排卵天數(shù)(Gn天數(shù))、促性腺素劑量(Gn劑量)、絨毛膜促性腺素注射日(HCG日)黃體生成素(LH)、雌激素(E2)、孕激素(P)水平、子宮內(nèi)膜厚度(En)及獲卵數(shù)、不同形態(tài)學(xué)分型卵母細胞數(shù)、卵母細胞受精數(shù)、正常受精數(shù)(2PN數(shù))、不同級別卵裂期胚胎數(shù)、優(yōu)質(zhì)胚胎數(shù)。結(jié)果:1)各組不孕癥患者的一般資料:年齡、不孕年限、竇卵泡數(shù)(AFC)、基礎(chǔ)卵泡刺激素(FSH)間比較差異無統(tǒng)計學(xué)意義。2)對既往卵巢反應(yīng)不良的促排卵周期,采用不同促排卵方案再次控制性超促排卵后,共23個周期出現(xiàn)卵巢低反應(yīng),包括拮抗劑方案組6個周期,發(fā)生率為16.7%,短方案組9個周期,發(fā)生率為28.1%,長方案組8個周期,發(fā)生率為26.6%。但三組間卵巢低反應(yīng)發(fā)生率差異無統(tǒng)計學(xué)意義。且三組方案均無周期取消發(fā)生。3)排除卵巢低反應(yīng)型卵巢反應(yīng)不良周期,剩余75個卵巢反應(yīng)不良周期中,Gn天數(shù)、Gn劑量三組間比較差異有統(tǒng)計學(xué)意義,長方案組顯著較高。HCG日黃體生成素(LH)水平短方案組較長方案組和拮抗劑方案組顯著增高(4.42±1.17 vs 1.31±1.22 vs 2.52±1.95),差異有統(tǒng)計學(xué)意義(P0.05)。4)短方案組獲卵數(shù)顯著高于長方案組(6.65±1.72 vs 5.18±1.36),差異有統(tǒng)計學(xué)意義。不同形態(tài)學(xué)卵母細胞成熟度分析,生發(fā)泡期(GV期)、第一次減數(shù)分裂期(MI期)、退化卵母細胞數(shù)三組間差異無統(tǒng)計學(xué)意義,短方案組第二次減數(shù)分裂期卵母細胞數(shù)(MII期)顯著高于長方案組(5.52±1.53 vs 4.04±1.25)。但不同組間各期卵母細胞占總獲卵數(shù)的比例差異無顯著統(tǒng)計學(xué)意義。5)三組方案間卵母細胞受精數(shù)、2PN數(shù)、卵裂期胚胎數(shù)及優(yōu)質(zhì)胚胎數(shù)間差異有統(tǒng)計學(xué)意義,而拮抗劑方案組與短方案組間差異無統(tǒng)計學(xué)意義。長方案組受精率、優(yōu)質(zhì)胚胎率低于短方案和拮抗劑方案組,但2PN率和卵裂期胚胎率三組方案間差異無統(tǒng)計學(xué)意義。結(jié)論:1)長方案使卵巢反應(yīng)不良患者發(fā)生卵巢低反應(yīng)的概率增加。2)長方案的獲卵數(shù)和MII期卵母細胞數(shù)低于短方案和拮抗劑方案,但各期卵母細胞占獲卵數(shù)的比例三組方案間無差異。3)短方案和抗劑方案的卵母細胞受精數(shù)、正常受精數(shù)、胚胎數(shù)和優(yōu)胚數(shù)高于長方案,且受精率和優(yōu)胚率高于長方案。4)拮抗劑方案和短方案可作為卵巢反應(yīng)不良患者促排卵治療時首選方案,但短方案需密切監(jiān)測LH水平。
[Abstract]:Objective: to retrospectively analyze the difference of oocyte outcome and oocyte fertilization development ability of three different ovulation promotion protocols in infertile patients with ovarian adverse reaction after controlled hyperstimulation of ovulation. To explore the first choice of ovulation promotion in patients with poor ovarian reaction. Methods: from January 2014 to March 2016, 98 cycles of infertile women with poor ovarian response and repeated assisted pregnancy therapy were collected. Record the general status of selected patients, including basal sex hormone levels during menstruation. All the selected cycles were divided into three groups according to the different ovulatory protocols used in the treatment: 30 cycles in the long luteal phase descending control group 32 cycles in the short regimen group and 36 cycles in the antagonist regimen group. The number of days of ovulation induction, gonadotropin (Gn), chorionic gonadotropin (HCG), the levels of luteinizing hormone (LHH), estrogen, progesterone (P), endometrial thickness (Eng) and the number of eggs obtained were analyzed in three groups. The number of oocytes of different morphologic credit types, the number of oocytes fertilized, the number of normal fertilization (2PN), the number of embryos at different cleavage stage, the number of high quality embryos. Results: there was no significant difference in age, age, length of infertility, number of antral follicles and FSHs of basal follicle stimulating hormone (FSHs). There were 23 cycles of ovarian hyporesponse, including 6 cycles in the antagonist group, 9 cycles in the short regimen group, and 8 cycles in the long regimen group, respectively, after repeated controlled hyperstimulation of ovulation with different ovulatory regimens, including 6 cycles in the antagonist regimen group with an incidence rate of 16.7 cycles, 9 cycles in the short regimen group and 28.1 cycles in the long regimen group. The incidence was 26.6%. However, there was no significant difference in the incidence of ovarian hyporesponse among the three groups. No cycle cancellations occurred. 3) ovarial low reactive ovarian adverse reaction cycles were excluded in all three groups. There was a significant difference among the three groups in the number of days of Gn and the dosage of Gn in the remaining 75 cycles of poor ovarian reaction. The level of LH in the long regimen group was significantly higher than that in the long regimen group and the antagonist regimen group. The number of eggs obtained in the short regimen group was significantly higher than that in the long regimen group and the antagonist regimen group (4.42 鹵1.17 vs 1.31 鹵1.22 vs 2.52 鹵1.95). The number of eggs obtained in the short regimen group was significantly higher than that in the long regimen group (6.65 鹵1.72 vs 5.18 鹵1.36). The difference is statistically significant. There was no significant difference in the number of degenerated oocytes among the three groups, including GV stage, MI phase and degenerative oocyte number in the first meiosis stage, and there was no significant difference among the three groups in the maturation of different morphologic oocytes. The number of oocytes in the second meiosis phase in the short regimen group was significantly higher than that in the long regimen group (5.52 鹵1.53 vs 4.04 鹵1.25). However, there was no significant difference in the proportion of oocytes to the total number of oocytes among different groups. 5) the fertilization number of oocytes was 2PN, the number of embryos at cleavage stage and the number of high-quality embryos were significantly different among the three groups. However, there was no significant difference between the antagonist regimen group and the short regimen group. The fertilization rate and high quality embryo rate in the long regimen group were lower than those in the short and antagonist regimen groups, but there was no significant difference in 2PN rate and cleavage embryo rate among the three groups. Conclusion: 1) the probability of ovarian hyporesponse in patients with poor ovarian reaction increased by 1: 1) the number of oocytes obtained and the number of oocytes in MII phase of the long regimen were lower than those of short regimen and antagonist regimen. However, the proportion of oocytes in each stage in the three groups had no difference. 3) the number of oocytes fertilized, the number of normal fertilization, the number of embryos and the number of superior embryos were higher than those of the long scheme. The fertilization rate and embryo rate were higher than those of the long regimen. 4) antagonist regimen and short regimen could be the first choice for ovulation promotion in patients with poor ovarian reaction, but the LH level should be closely monitored by the short regimen.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.8

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