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目的观察口服避孕药(OCP)在体外受精-胚胎移植(IVF-ET)短方案促排卵中的作用。方法对因输卵管因素或男方因素行IVF-ET的不孕患者共112例,均采用短方案促排卵,其中实验组59例,于促排卵前给予OCP口服1个月;对照组53例,促排卵前不给予OCP预处理,常规月经第3天促排卵。比较两组患者自然月经周期D3天和COH周期月经D3天的基础卵泡及内分泌情况;比较两组Gn使用天数、Cn总量、HCG日LH、E2、P水平;比较两组取卵日成熟卵泡情况、获卵数、受精率、卵裂率、可用胚胎数、优质胚胎数、周期取消率、临床妊娠率的差异。结果①两组患者的年龄、不孕年限、自然月经周期基础FSH、LH、E2比较无显著性差异(均P>0.05);两组患者COH周期月经D3天FSH、LH、E2水平及HCG日LH、E2、P水平比较无显著性差异(均P>0.05);②COH周期月经D3天有>5mm卵泡的患者数,实验组较对照组明显减少(P<0.05),实验组卵泡发育同步性好,卵泡大小相对较均匀;③平均Gn天数及用量实验组较对照组多(P<0.05);④周期取消率实验组较对照组低(P<0.05);⑤取卵日≥15mm成熟卵泡数、获卵数、可移植胚胎数、临床妊娠率实验组较对照组高(P<0.05);⑥两组受精率、卵裂率、优质胚胎数等差异无显著性(均P>0.05)。结论在IVF-ET短方案中,在GnRH-a+Gn促排卵前用OCP预处理,能调整月经周期,使卵泡发育同步性增加,能获得比较好的促排卵效果,取卵日成熟卵泡数及获得的卵子数均较多,周期取消率降低,临床妊娠率能够得到适当的提高。但OCP预处理后可能抑制了早期内源性FSH的上升,对卵巢的抑制加重,使小卵泡发育缓慢而用药时间延长。
Objective To observe the role of oral contraceptives (OCPs) in ovulation induction by short-term IVF-ET (IVF-ET). Methods A total of 112 patients with infertility who underwent IVF-ET due to fallopian tube factor or male factor were treated with short-term ovulation induction. Among them, 59 patients in the experimental group were orally administered orally for one month before ovulation induction; and 53 patients in the control group were promoted OCP pretreatment is not given Ovulation, ovulation on the 3rd day of conventional menstruation. The basal follicles and endocrine of D3 days of natural menstrual cycle and D3 days of COH cycle were compared between the two groups. The days of Gn use, the total amount of Cn, LH, E2 and P of HCG were compared between the two groups. Situation, number of oocytes retrieved, fertilization rate, cleavage rate, number of available embryos, number of high quality embryos, cycle cancellation rate and clinical pregnancy rate. Results ①The FSH, LH and E2 of the two groups had no significant difference in the age, the duration of infertility and the natural menstrual cycle (all P> 0.05). The levels of FSH, LH and E2 on D3 days of COH cycle and HCG (P> 0.05). ②The number of patients with> 5 follicles in the D3 period of the COH cycle was significantly lower than that of the control group (P <0.05), the synchronization of follicle development in the experimental group The follicle size was relatively uniform; ③The mean Gn days and dosage were higher in the experimental group than in the control group (P <0.05); ④ The cycle cancellation rate was lower in the experimental group than in the control group (P <0.05) The number of fertilized eggs, the number of transplanted embryos and the clinical pregnancy rate were higher in the experimental group than those in the control group (P <0.05). There was no significant difference in fertilization rate, cleavage rate, number of high quality embryos between the two groups (all P> 0.05) . Conclusions In IVF-ET short-term regimen, pretreatment with OCP before GnRH-a + Gn pro-ovulation can adjust the menstrual cycle to increase the synchronization of follicle development and achieve better ovulation induction effect. The number of mature follicles at ovulation day And the number of eggs obtained are more cycles to reduce the rate of cancellation, the clinical pregnancy rate can be properly increased. However, OCP pretreatment may inhibit the early rise of endogenous FSH, increased inhibition of the ovary, so that the development of small follicles slow and prolonged medication.