Reproductive Medicine Center, Department of Obstetrics and Gynaecology, General Hospital of Tianjin Medical University, Tianjin 300052, China.
Chin Med J (Engl). 2012 Aug;125(16):2837-40.
The successful end-point of in vitro fertilization (IVF) treatment is for a woman to give live birth. This outcome is based on various factors including adequate number of retrieved eggs. Failure to recruit adequate follicles, from which the eggs are retrieved, is called a "poor response". How to improve the clinical pregnancy rates of poor responders was one of the tough problems for IVF.
The study involved 51 patients who responded poorly to high dose gonadotropin treatment in their previous cycles at our reproductive center, between April 2010 and February 2012. The previous cycle (group A) received routine long protocol; the subsequent cycle (group B) received modified super-long down-regulation protocol. The primary outcome of the study was the number of oocytes fertilized. The increase in the pregnancy rate was the secondary outcome. Differences between the groups were assessed by using Student's t test and c(2) test where appropriate.
The patients' average age was (36.64 ± 3.85) years. The mean duration of ovarian stimulation cycles of the group A patients was longer than those of the group B patients. The total dose of follicle-stimulating hormone (FSH) was significantly lower in the subsequent cycle. The peak value of serum estradiol on human chorionic gonadotrophin (hCG) day was lower in group A as compared with group B. The number of metaphase II oocytes recovered was significantly higher in group B. The cleavage rate in group A was significantly lower than in group B, 49 patients in group B reached embryo transfer stage, while 46 patients in group A reached this stage. Patients in group B received significantly more embryos per transfer as compared with group A. More pregnancies and more clinical pregnancies with fetal heart activity were achieved in group B.
This comparative trial shows that poor responder women undergoing repeated assisted reproduction treatment using modified super-long down-regulation protocol achieve more oocytes, leading to higher fertilization rate, compared to women receiving routine long protocol. Our study also showed that clinical pregnancy rate was significantly improved.
体外受精（IVF）治疗的成功终点是女性活产。这一结果基于各种因素，包括足够数量的取卵。未能招募到足够数量的卵泡（卵子从中取出）称为“反应不良”。如何提高反应不良患者的临床妊娠率是 IVF 的难题之一。
本研究纳入了 2010 年 4 月至 2012 年 2 月在我院生殖中心接受高剂量促性腺激素治疗反应不良的 51 例患者。前一周期（A 组）接受常规长方案；随后周期（B 组）接受改良超长降调节方案。本研究的主要结局是受精的卵母细胞数量。次要结局是妊娠率的增加。采用 Student's t 检验和 c(2)检验评估组间差异。
患者平均年龄（36.64 ± 3.85）岁。A 组患者卵巢刺激周期的平均持续时间长于 B 组。随后周期的卵泡刺激素（FSH）总剂量显著降低。hCG 日血清雌二醇的峰值 A 组低于 B 组。B 组回收的中期 II 卵母细胞数量明显高于 A 组。A 组的卵裂率明显低于 B 组，B 组有 49 例患者达到胚胎移植阶段，而 A 组有 46 例患者达到该阶段。B 组患者每次移植接受的胚胎数量明显多于 A 组。B 组的妊娠率和有胎心的临床妊娠率更高。
本对照试验表明，与接受常规长方案的反应不良女性相比，接受改良超长降调节方案重复辅助生殖治疗的反应不良女性获得了更多的卵母细胞，受精率更高。我们的研究还表明，临床妊娠率显著提高。
