辅酶Q10联合维生素E对高龄女性卵巢功能及IVF结局的影响

摘要

目的 研究体外受精-胚胎移植(IVF-ET)前联合使用辅酶Q10与维生素E对高龄女性卵巢功能及IVF结局的影响.方法 纳入因卵巢功能低下行IVF-ET的152个周期的高龄女性(＞35岁)患者,随机分为3组给以不同的预处理方案:A组(对照,n=46)、B组(仅维生素E,n=53)和C组(辅酶Q10联合维生素E,n=53);并根据患者年龄进一步分为两个亚组,35～40岁患者纳入组1(A1/B1/C1),40岁以上患者纳入组2(A2/B2/C2).比较各预处理方案组的卵巢储备指标、卵巢反应性和IVF结局. 结果 (1)35～40岁患者:C1组窦卵泡数(AFC)显著高于A1和B1组(P＜0.05),且C1组bFSH、bE2水平显著低于A1和B1组(P＜0.05);而B1组bFSH水平显著低于A1组(P＜0.05),但AFC与之无统计差异(P＞0.05);C1组Gn总量、Gn天数显著低于A1和B1组,且促排卵E2峰值水平、HCG日子宫内膜厚度及获卵数均显著高于A1和B1组(P＜0.05),而A1与B1组比较以上观察指标均无统计学差异(P＞0.05);(2)40岁以上患者:C2组AFC显著高于A2和B2组(P＜0.05),且C2组bFSH、bE2水平显著低于A2和B2组(P＜0.05);B2组bFSH、bE2和AFC与A2组相比均无统计学差异(P＞0.05);C2组Gn总量、Gn天数显著低于A2和B2组,且促排卵E2峰值水平、HCG日子宫内膜厚度及获卵数均显著高于A2和1B2组(P＜0.05),而A2与B2组比较以上观察指标均无统计学差异(P＞0.05);(3)两个年龄组内各预处理方案之间比较,优胚数及临床妊娠率均无统计学差异(P＞0.05). 结论 无论对于35～40岁或者40岁以上女性患者,辅酶Q10联合维生素E可协同改善高龄女性的卵巢储备和卵巢反应性,对IVF结局的影响虽无统计学差异,但尚有一定的改善趋势.%Objective:To investigate effect of co-enzyme Q10 combined with vitamin E on ovary reserve and IVF outcome of women with advanced age.Methods:A total of 152 cycles of the women with advanced age were randomly divided into three groups:group A as control(n=46),group B as supplementation of vitamin E only(n=53),and group C as supplementation of co-enzyme Q10 combined with vitamin E(n=53).Furthermore,the patients were subdivided into two groups:the patients aged between 35 to 40 years in group1 (A1/B1/C1)and the patients aged over 40 years in group 2 (A2/B2/C2).The ovarian reserve index,ovarian response and IVF outcome were compared among the groups.Results:(1)For patients aged between 35 to 40 years:there were significant increases in antral follicle count(AFC)and significant decreases in basic levels of FSH and E2 in group C1 as compared with group A1 and B1(P＜0.05).There was a significant decrease in basic FSH(P＜0.05),but no difference in AFC(P＞ 0.05)in group B1 as compared with group A1.No matter compared with group A1 or B1,there were significant decreases in the dosage and days of Gn used,while significant increases in endometrium thickness on the HCG day,E2 peak level,number of oocytes retrieved in group C1(P＜0.05).There was no significant difference in the above indexes between A1 and B1 (P＞0.05).(2)For patients aged over 40 years:there were significant increase in AFC and significant decreases in basic levels of FSH and E2 in group C2 as compared with group A2 and B2(P＜0.05).There was no significant differences in basic levels of FSH & E2 and AFC between group B2 and group A2(P＞0.05).No matter compared with group A2 or B2,there were significant decreases in the dosage and days of Gn used,while significant increases in endometrium thickness on the HCG day,E2 peak level,number of oocytes retrieved in group C2(P＜0.05).There were no significant differences in dosage and days of Gn used,endometrium thickness on the HCG day,E2 peak level,number of oocytes retrieved between group B2 and A2 (P ＞ 0.05).(3)There were no significant differences in number of high-quality embryos and clinical pregnancy rates among the different pretreatment groups between the two age groups(P＞0.05).Conclusions:No matter for women aged between 35 to 40 years old or over 40 years old,application of Co-enzyme Q10 combined with vitamin E plays a beneficial effect on ovary reserve and ovary response in women with advanced age.The results reveal an improvement tendency in IVF outcome but no statistical difference.