2019 年第 7 期 第 14 卷

不同促排卵方案对高龄不孕患者的治疗效果比较

Clinical effects of different methods of ovulation induction on aged infertile patients

作者：张晶晶李宏杰高秀英吴小华喻单根郭纪红黄楠楠李芳枝

英文作者：

单位：056200河北省邯郸市，冀中能源峰峰集团有限公司总医院妇产科（张晶晶、李宏杰、黄楠楠、李芳枝），手术室（高秀英），骨科（喻单根），肿瘤科（郭纪红）；050082石家庄市妇产医院生殖医学中心（吴小华）

英文单位：

关键词：不孕症；高龄；醋酸曲普瑞林注射液；重组人促卵泡激素；枸橼酸氯米芬

英文关键词：

• 摘要：

• 【摘要】目的    比较3种不同促排卵方案对高龄不孕患者的治疗效果。方法    选择2015年10月至2017年12月于冀中能源峰峰集团有限公司总医院和石家庄市妇产医院接受辅助生殖助孕治疗且年龄≥35岁女性256例（共256个治疗周期）的临床资料进行回顾性分析。按促排卵方案的不同分为长方案组102例（102个周期）、拮抗剂组68例（68个周期）和微刺激组86例（86个周期）。比较3组患者的年龄、不孕时间、基础促黄体生成素(LH)、基础雌激素、基础卵泡刺激素(FSH)、促性腺激素（Gn）用药时间和总量、人绒毛膜促性腺激素(HCG)日LH、获卵数、优质胚胎数、周期取消率、临床妊娠率。结果    3组患者年龄、不孕时间、基础LH、基础雌激素、基础FSH水平比较差异均无统计学意义（均P＞0.05）。与长方案组比较，拮抗剂组和微刺激组患者Gn用药时间短、用药总量低，获卵数和优质胚胎数少，微刺激组患者HCG日LH水平和周期取消率高（均P＜0.05）；与拮抗剂组比较，微刺激组患者Gn用药时间短，Gn用药总量低，HCG日LH水平高，周期取消率高（均P＜0.05）。长方案组、拮抗剂组和微刺激组患者临床妊娠率［17.9%（12/67）、22.0%（9/41）比20.0%（2/10）］比较差异无统计学意义（P＞0.05）。结论    采用长方案促排卵治疗高龄不孕患者Gn用药剂量大、疗程长，临床结局改善不明显，因此长方案促排卵治疗高龄不孕可能不是最佳治疗方案。而拮抗剂方案相对于长方案用药时间短、用药剂量低，且周期取消率明显低于微刺激方案，临床妊娠率较高。

• 【Abstract】Objective    To investigate the effects of 3 methods of ovulation induction on the pregnancy outcome in aged patients with infertility. Methods    Clinical data of 256 female patients（≥35 years old） who received assisted reproductive therapy in Jizhong Energy Fengfeng Group Hospital and Shijiazhuang Obstetrics and Gynecotogy Hospital from October 2015 to December 2017 were retrospectively analyzed. According to the duration of ovulation induction, the patients were divided into long-term regimen group(102 cases, 102 cycles), antagonist group(68 cases, 68 cycles) and micro-stimulation group(86 cases, 86 cycles). Age, years of infertility, baseline levels of luteinizing hormone(LH), estrogen and follicle stimulating hormone(FSH), administration time and total dosage of gonadotropin(Gn), LH level on the day of human chorionic gonadotropin(HCG) administration, numbers of retrieved oocytes, numbers of high-quality embryos, cycle cancellation rate and clinical pregnancy rate were analyzed. Results    There were no significant differences of age, years of infertility, baseline levels of LH, estrogen and FSH among the three groups(all P＞0.05). Compared with the long-term regimen group, the antagonist group and micro-stimulation group had shorter duration and lower dosage of Gn administration, fewer oocytes and high-quality embryos; the micro-stimulation group had higher LH level on the day of HCG administration and higher cycle cancellation rate（all P＜0.05）. Compared with the antagonist group, administration time of Gn was shorter and the dosage was lower, LH level on the day of HCG administration and cycle cancellation rate were higher in the micro-stimulation group(all P＜0.05). There was no significant difference of clinical pregnancy rate among the long-term regimen group, antagonist group and micro-stimulation group［17.9%(12/67), 22.0%(9/41) vs 20.0%(2/10)］(P＞0.05). Conclusions    Long-term ovulation induction treating aged infertile patients needs high Gn dosage and long course; the improvement of clinical outcomes was not obvious. Antagonist regimen shows shorter medication period and lower dosage compared with long-term regimen. Cycle cancellation rate of antagonist regimen is lower than that of micro-stimulation regimen, and the clinical pregnancy rate is satisfactory.