摘要
目的 比较卵巢低反应(POR)患者自然周期取卵或排卵后黄体期促排卵的体外受精/卵细胞质内单精子注射(IVF/ICSI)的临床结局.方法 选择采用黄体期促排卵方案行IVF/ICSI助孕的POR患者418例,根据是否实施自然周期取卵分为两组,其中自然周期取卵后行黄体期促排卵169例为A组、自然周期排卵后行黄体期促排卵249例为B组.比较两组黄体期促排卵的获卵数、成熟卵子数、双原核(2PN)受精数、冷冻囊胚(简称冻胚)数、发育天数为第5天的囊胚(D5囊胚)数,以及未获卵周期、无囊胚形成周期的占比;记录A组自然周期的获卵率、获冻胚率及自然周期和黄体期促排卵两次取卵的总获卵数、总冻胚数;比较两组黄体期促排卵使用促性腺激素(Gn)天数、Gn总量及首次移植黄体期促排卵所获冻胚的生化妊娠率、临床妊娠率、早期流产率、活产率.结果 A组黄体期促排卵的获卵数、成熟卵子数、2PN受精数、冻胚数均低于B组,无囊胚形成周期占比高于B组(P均<0.05).A、B组黄体期促排卵的D5囊胚数、未获卵周期占比比较P均>0.05.A组自然周期获卵率为72.78%(123/169),均为1枚;自然周期获冻胚率为22.49%(38/169),均为1枚;A组总获卵数4(3,7)个、总获冻胚数2(1,3)个,B组分别为5(3,8)、2(1,3)个,两组比较P均>0.05.A、B组使用Gn天数、Gn总量及首次移植黄体期促排卵所获冻胚的生化妊娠率、临床妊娠率、早期流产率、活产率比较P均>0.05.结论 自然周期取卵、排卵的POR患者整体上获卵获胚情况、黄体期促排卵后的胚胎质量及IVF/ICSI结局是相近的,但自然周期排卵的POR患者在后续黄体期促排卵阶段有更多的获卵及获胚.
Abstract
Objective To compare the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)of luteal-phase stimulation after oocyte retrieval in natural cycle or natural ovulation in poor ovarian respond-ers.Methods Totally 418 poor ovarian response patients who underwent IVF/ICSI with luteal-phase stimulation were se-lected.They were divided into two groups based on whether the dominant follicle in the natural cycle was retrievaled or not.Among them,169 cases underwent luteal-phase stimulation after oocyte retrieval in natural cycle(Group A),and 249 cases underwent luteal-phase stimulation after natural ovulation(Group B).We compared the numbers of oocytes re-trieved,mature oocytes,2 pronuclcus(2PN)fertilizations,frozen blastocysts,blastocysts of development on the 5th day(D5 blastocysts),and the proportions of non-oocyte and non-frozen blastocyst between the two groups with luteal-phase stimulation.We recorded the oocyte retrieval rate and blastocyst frozen rate of natural cycle,and the total numbers of oo-cytes retrieved and frozen blastocysts obtained from the natural cycle and luteal-phase stimulation in the Group A.We com-pared the days of stimulation and total additional doses of gonadotropin(Gn)of luteal-phase stimulation,and the biochemi-cal pregnancy rate,clinical pregnancy rate,early miscarriage rate,live birth rate of the first transplantation of frozen blas-tocyst which was obtained from the luteal-phase stimulation between the two groups.Results Compared with Group A,the Group B had significantly larger numbers of oocytes retrieved,mature oocytes,2PN fertilizations,and frozen blasto-cysts with luteal-phase stimulation(all P<0.05);the proportion of non-frozen blastocyst with luteal-phase stimulation in the Group A was significantly higher than that in the Group B(P<0.05).There were no significant differences in the num-bers of D5 blastocysts or the proportions of non-oocyte with luteal-phase stimulation between the Group A and Group B(all P>0.05).In the Group A,the oocyte retrieval rate of natural cycle was 72.78%(123/169),with an average of one oo-cyte retrieved per case;the blastocyst frozen rate of natural cycle was 22.49%(38/169),and all cases obtained one fro-zen blastocyst each.The total number of Group A of oocytes retrieved was 4(3,7)and the total number of frozen blasto-cysts was 2(1,3),while the numbers of Group B were 5(3,8)and 2(1,3),with no significant difference(all P>0.05).No significant differences were found in the days of stimulation,total additional doses of Gn,the biochemical preg-nancy rate,clinical pregnancy rate,early miscarriage rate,or live birth rate of the first transplantation of frozen blastocyst which was obtained from the luteal-phase stimulation(all P>0.05).Conclusions The overall numbers of oocytes re-trieved and frozen blastocysts of poor ovarian responders with oocyte retrieval in natural cycle and natural ovulation are sim-ilar,as well as the embryo quality and the IVF/ICSI outcomes of the subsequent luteal-phase stimulation.However,there are larger numbers of oocytes retrieved and frozen blastocysts of luteal-phase stimulation after natural ovulation in patients with poor ovarian response.
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