微刺激全胚胎冷冻方案在高龄患者中的应用

摘要

目的 探讨微刺激全胚胎冷冻方案在高龄患者中的应用价值. 方法 对542例年龄≥38岁、应用微刺激方案行IVF/ICSI-FET的1 020个周期进行回顾性分析,根据患者年龄分为3组:A组(38～＜40岁);B组(40～＜43岁);C组(≥43岁),比较3组间月经第3天FSH、Gn总量、Gn天数、平均获卵数、成熟卵母细胞总数、胚胎形成数、胚胎冷冻数以及妊娠结局. 结果 1 020个刺激周期中119个周期因卵巢反应不良放弃周期,周期取消率11.67％;1 001个取卵周期中69个周期获卵失败,平均获卵率93.11％.932个周期获得卵母细胞,平均获卵数(1.98±1.40)个,共565个周期有胚胎冷冻,胚胎冷冻率60.62％.3组比较HCG日卵泡数、获卵数无显著性差异(P＞0.05),月经第3天FSH水平、Gn天数、成熟卵母细胞数、胚胎形成数、胚胎冷冻数组间有显著性差异(P＜0.05),其中B组的Gn天数、Gn总量、成熟卵母细胞数、胚胎冷冻数显著高于C组(P＜0.05),C组的成熟卵母细胞数、胚胎冷冻数显著低于其他两组(P＜0.05).342人共行585个移植周期,移植周期的妊娠率为20.00％,移植周期的累积妊娠率为34.21％,起始周期的累积妊娠率为21.59％.3组中随着年龄的增加,妊娠率逐渐下降(P＜0.05). 结论 高龄患者使用微刺激全胚冷冻方案可以获得相对满意的妊娠结局,不失为临床上的一个选择.但针对高龄患者如何根据年龄、卵巢储备功能和前次促排卵治疗结果制定适宜的治疗方案,有待于进一步的随机对照试验探讨.%Objective:To investigate the application value of mild stimulation protocol in elderly patients.Methods:A total of 542 patients aged≥38 years undergone 1 020 cycles with mild stimulation mild stimulation and whole embryo frozen protocol in IVF/ICSI were retrospectively analyzed.The patients were divided into 3 groups according to the age:group A (38-39 years),group B (40-42 years),and group C (≥43 years).The FSH levels on the third day of the menstrual cycle,dosage of gonadotropin (Gn) used,Gn days,average number of oocytes retrieved,number of mature oocytes,number of embryos,number of frozen embryos and pregnancy outcome were compared among the three groups.Results:One hundred and nineteen cycles in 1 020 stimulation cycle were abandoned due to poor ovarian response,and the cycle cancellation rate was 11.67 ％.The oocytes retrieval of sixty nine cycles in 1 001 cycles was failure,and the oocytes retrieval rate was 93.11％.The oocytes retrieval of 932 cycles was successful,and the average number of oocytes retrieved was (1.98± 1.40).A total of 565 cycles got frozen embryos,and the embryo frozen rate was 60.62％.The average number of oocytes retrieved and the number of frozen embryos in B group were significantly higher than those in group C (P＜0.05).There was no significant difference in the number of oocytes retrieved (P＞0.05),but the FSH level on 3nd of menstrual cycle,Gn used days,number of mature oocytes,number of formed embryos & frozen embryo were significantly different among the three groups (P＜0.05).Among them,Gn used days,total doses of Gn used,number of mature oocytes,and number of frozen embryos in group B were significantly higher than those in group C (P＜0.05).The number of mature oocytes and number of frozen embryos in group C was significantly less than those in the other two groups (P＜0.05).A total of 585 transplant cycles were performed in 342 patients,the pregnancy rate per transplantation cycle was 20.00 ％,and the cumulative pregnancy rate of the transfer cycle was 34.21％.The cumulative pregnancy rate of initial cycle was 21.59％.The pregnancy rate was significantly decreased with the increase of age (P＜0.05).Conclusions:Elderly patients with mild stimulation and whole embryo frozen protocol can get relatively satisfactory pregnancy outcome,and it is a good choice.How to develop appropriate treatment protocol based on age,ovarian reserve function,and previous ovulation outcomes for the elder patients should be explored in further randomized controlled trials.