黄体期和刺激期雌激素预处理对体外受精中反应不良者的影响。
Effect of estrogen priming through luteal phase and stimulation phase in poor responders in in-vitro fertilization.
机构信息
Fertility Center of CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, College of Medicine, CHA University, 650-9 Yeoksam, Kangnamgu, Seoul 135-081, Korea.
出版信息
J Assist Reprod Genet. 2012 Mar;29(3):225-30. doi: 10.1007/s10815-011-9685-7. Epub 2011 Dec 8.
PURPOSE
To verify whether a novel protocol administering E(2) during the luteal phase of the preceding cycle and during ovarian stimulation in GnRH antagonist cycle could enhance follicular response and hence improve outcomes in poor responders.
METHODS
In this retrospective analysis, a total of 155 poor responder patients subjected to IVF/ICSI were analyzed. All the patients had history of more than one prior IVF cycle failure with poor response (less than 5 oocytes retrieved and/or maximal E₂ level less than 500 pg/mL) by using conventional long agonist or antagonist protocol. In luteal E2 treatment protocol (n = 86), oral estradiol valerate 4 mg/day was initiated on luteal day 21 and either stopped at menstrual cycle day 3 (Protocol A, n = 28) or continued during the period of ovarian stimulation until the day of hCG injection (Protocol B, n = 58). IVF parameters and pregnancy outcome of luteal E2 treatments group were compared with a standard GnRH antagonist protocol (n = 69) which the patients received no hormonal pretreatment.
RESULTS
Compared to standard GnRH antagonist protocol, cancellation rate was lower with luteal E2 group (15.1% vs 37.7%, p < 0.01). Moreover, patients treated with luteal estrogen resulted in an increased number of oocytes retrieved (4.5 ± 2.9 vs 3.2 ± 1.9; p < 0.01). A trend toward increase in number of normally fertilized embryos (2.9 ± 2.1vs 2.3 ± 1.9; p = 0.043), and increased prevalence of good quality embryos (51.2% vs 25%; p = 0.047) were noted. Comparing protocol A and B, there were no significant difference between embryologic data, however there were slight increase in ongoing pregnancy rate in protocol B compared to A (27.1% vs 20%, p = 0.357), although statistical significance was not achieved.
CONCLUSION
Estrogen priming through luteal phase and stimulation phase improved ovarian responsiveness and this may lead to an increase in pregnancy rate in poor responders with failed cycle.
目的
验证在 GnRH 拮抗剂周期的黄体期和卵巢刺激期间给予 E（2）的新方案是否可以增强卵泡反应，从而改善反应不良者的结局。
方法
在这项回顾性分析中，对 155 名接受 IVF/ICSI 的反应不良患者进行了分析。所有患者均有既往多次 IVF 周期失败的病史，反应不良（取卵数少于 5 个和/或最大 E₂水平低于 500 pg/mL），采用常规长激动剂或拮抗剂方案。在黄体 E2 治疗方案中（n=86），于黄体期第 21 天开始口服戊酸雌二醇 4 mg/天，如果在月经周期第 3 天停药（方案 A，n=28）或在卵巢刺激期间继续使用直至 hCG 注射日（方案 B，n=58）。黄体 E2 治疗组的 IVF 参数和妊娠结局与接受无激素预处理的标准 GnRH 拮抗剂方案组（n=69）进行比较。
结果
与标准 GnRH 拮抗剂方案相比，黄体 E2 组的取消率较低（15.1% vs 37.7%，p<0.01）。此外，接受黄体雌激素治疗的患者获得的可受精卵数量增加（4.5±2.9 个 vs 3.2±1.9 个；p<0.01）。可受精胚胎数量略有增加的趋势（2.9±2.1 个 vs 2.3±1.9 个；p=0.043），优质胚胎的比例也有所增加（51.2% vs 25%；p=0.047）。方案 A 和方案 B 之间的胚胎学数据无显著差异，但方案 B 的持续妊娠率略高于方案 A（27.1% vs 20%，p=0.357），尽管未达到统计学意义。
结论
黄体期和刺激期的雌激素预处理可改善卵巢反应性，从而提高反应不良患者的妊娠率。
Zotero 插件