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目的:探讨自然周期体外受精-胚胎移植(NC-IVF-ET)和超促排卵周期体外受精-胚胎移植(COH-IVF-ET)在卵巢低储备低反应患者中的临床应用价值。方法:回顾性分析2007年6月～2010年12月接受IVF治疗的170名卵巢储备功能降低的低反应患者共249个IVF治疗周期,按治疗方案分为A组(NC-IVF-ET组)(87周期)和B组(COH-IVF-ET组)(162周期);有24名患者先后行过两种方案共66个治疗周期,同样按方案分为C组(NC-IVF组)(36周期)和D组(COH-IVF组)(30周期)。使用spss13.0统计软件分别对各分组的一般情况、治疗情况及结局行对照分析。结果:A组患者年龄较B组小,窦状卵泡数(AFC)较少,基础卵泡刺激素(FSH)较高,但两组不孕年限差异无统计学意义;A组患者的促性腺激素(Gn)用量、HCG日的雌二醇(E2)水平、内膜厚度及各径线的卵泡数均低于B组;A组较B组抽吸的卵泡数、获卵数、移植胚胎数均较少,获卵率较低,周期取消率较高,差异有统计学意义;而两组间正常受精率、卵裂率、优质胚胎率、胚胎种植率、移植周期的临床妊娠率及早期自然流产率比较差异均无统计学意义。C组年龄和窦状卵泡数较D组低,基础FSH水平较高,两组间不孕年限无统计学差别;C组的Gn用量、HCG日E2水平、内膜厚度及各径线卵泡数均低于D组,差异有统计学意义;两组相比,C组抽吸的卵泡数、获卵数、移植胚胎数均较少,获卵率较低,周期取消率较高,差异有统计学意义;但C、D两组间正常受精率、卵裂率、优质胚胎率、胚胎种植率、移植周期的临床妊娠率比较差异均无统计学意义。结论:对于卵巢储备降低的卵巢低反应患者,自然周期IVF与超促排卵IVF各有利弊,可综合患者各方面条件,灵活选择治疗方案。
Objective: To investigate the clinical value of natural cycle IVF-ET and COH-IVF-ET in patients with low reserve and low ovarian response. METHODS: A total of 249 IVF cycles of 170 low-responders with reduced ovarian reserve undergoing IVF from June 2007 to December 2010 were retrospectively analyzed. Patients were divided into group A (NC-IVF-ET group) (87 cycles) and group B (COH-IVF-ET) (162 cycles). Twenty-four patients underwent two cycles of treatment with 66 cycles in total and were equally divided into group C (NC-IVF) 36 cycles) and Group D (COH-IVF group) (30 cycles). Use spss13.0 statistical software for the general situation of each group, treatment and outcome of the line control analysis. Results: The age of group A was smaller than that of group B, the number of antral follicles (AFC) was less and the basal follicle stimulating hormone (FSH) was higher, but there was no significant difference between the two groups in the duration of infertility. A group of patients with gonadotropin (Gn), the level of estradiol (E2) on day HCG, the thickness of intima and the number of follicles in each diameter were lower than those in group B. The numbers of follicles, number of oocytes retrieved, number of transferred embryos The rate of cleavage, the rate of good embryo implantation, the rate of embryo implantation, the clinical pregnancy rate of the transplantation cycle and the early pregnancy rate There was no significant difference in spontaneous abortion rate. The age of group C and the number of antral follicles were lower than those in group D, and the basal FSH levels were higher. There was no significant difference in the duration of infertility between the two groups. The amount of Gn, the level of E2 on HCG, the thickness of intima, Were lower than the D group, the difference was statistically significant; two groups compared to the C group sucked the number of follicles, the number of oocytes, the number of embryos transferred were lower, lower egg recovery rate, higher cycle cancellation rate, the difference was However, there was no significant difference in normal pregnancy rate, normal fertilization rate, cleavage rate, high-quality embryo rate, embryo implantation rate, and clinical pregnancy rate between the two groups. CONCLUSIONS: For patients with ovarian depression who have decreased ovarian reserve, there are pros and cons of natural cycles of IVF and IVF, which can be combined with various aspects of patients and flexible treatment options.