高龄IVF患者应用黄体期促排卵方案与GnRH-a超短方案的助孕结局比较

Comparison of pregnancy outcomes of luteal-phase ovulation and GnRH-a ultra-short program in aged patients with IVF

摘要:

目的观察黄体期促排卵方案与GnRH-a 超短方案在行体外受精- 胚胎移植（IVF-ET）助孕高龄患者中的应用，探讨黄体期促排卵方案的有效性及可行性。方法对114例高龄患者161个IVF-ET周期过程及结局进行回顾性分析，其中，GnRH-a 超短方案83 例（A 组）、黄体期促排卵方案31 例（B 组），比较两种方案的促排卵效果及妊娠结局。结果与A组相比，B组人绝经期促性腺激素用量较多、重组促卵泡激素用量较少、促性腺激素（Gn）用量较多、Gn费用较少及受精率较高，优质胚胎率较低，组间比较，差异有统计学意义（P <0.05）。两组患者在年龄、不孕年限、体重指数、基础卵泡刺激素、基础黄体生成素、基础雌二醇、Gn天数、扳机日雌二醇水平、平均获卵数、2PN、可利用胚胎数、可移植胚胎率、临床妊娠率及早期流产率等方面比较，差异无统计学意义（P >0.05）。结论对于高龄患者，黄体期促排卵方案与GnRH-a 超短方案相比，在Gn费用较少的情况下有较高的受精率，且两组在总获卵数、可利用胚胎率及妊娠结局等方面比较，差异无统计学意义（P >0.05），提示黄体期促排卵方案可作为高龄IVF患者理想的治疗方案。

Abstract:

Objective To observe the application of luteal-phase ovulation and gonadotropin -releasing hormone-a (GnRH-a) ultra-short program in elderly patients with fertilization and embryo transfer (IVF-ET) and to explore the effectiveness and feasibility of ovulation induction in luteal phase. Methods A total of 114 patients with advanced age were retrospectively analyzed, among which 83 cases took ultra-short program (group A) and 31 cases received ovulation induction of luteal phase (group B). The ovulationinduction effect and pregnancy outcomes were compared between the two groups. Results Compared with the group A, the dosage of human menopausal gonadotropin was larger, the dosage of recombinant follicle stimulating hormone was smaller, the cost of gonadotropin (Gn) was lower, and the fertilization rate was higher,the rate of high quality embryos was lower in the group B (P < 0.05). There was no significant difference in age, infertility duration, BMI, basal follicle stimulating hormone, basal luteinizing hormone, basal estradiol, Gn days, triggering estradiol, 2PN cleavage rate, the number of available embryos, the rate of transplantable embryo, clinical pregnancy rate or early abortion rate between the two groups (P > 0.05). Conclusions In the elderly patients, the luteal-phase ovulation induction program has a higher rate of fertilization in the case of low Gn cost compared with the ultra-short program, and the two programs have no significant difference in the total number of oocytes retrieved, the available embryo rate or pregnancy outcome, suggesting that lutealphase ovulation induction program can be used as an ideal treatment for elderly patients with IVF.