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生长激素预处理六周可改善体外受精治疗中卵巢反应不良患者的临床结局:一项自身对照临床研究。

Six-week pretreatment with growth hormone improves clinical outcomes of poor ovarian responders undergoing in vitro fertilization treatment: A self-controlled clinical study.

作者信息

Cai Mei-Hong, Liang Xiao-Yan, Wu Yao-Qiu, Huang Rui, Yang Xing

机构信息

Reproductive Medicine Centre, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.

Department of Reproductive Medicine Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.

出版信息

J Obstet Gynaecol Res. 2019 Feb;45(2):376-381. doi: 10.1111/jog.13823. Epub 2018 Oct 1.

Abstract

AIM

The purpose was to explore whether the 6 weeks of growth hormone (GH) pretreatment could increase the live birth rate of poor ovarian responders (POR).

METHODS

This self-controlled, retrospective study was performed among 380 POR who had GH adjuvant (GH+) at a university-affiliated hospital in Guangzhou, China, from October 2010 to April 2016. Growth hormone was injected daily beginning with the previous menstruation and maintained until ovum pickup, for approximately 6 weeks. Clinical variables between the GH+ cycle and the other GH-free (GH-) cycle of each patient were compared. Both cycles were conducted with a similar conventional control ovarian hyperstimulation protocol for in vitro fertilization treatment. One to one case-control matching was performed to adjust essential confounding factors between GH+ cycles and GH- cycles.

RESULTS

GH pretreatment improved embryo quality (1.14 ± 1.50 vs 0.11 ± 0.48, P < 0.05) and decreased miscarriage (18.8% vs 80.0%, P < 0.05) significantly, resulting in an increase in the live birth rate (23.5% vs 3.9%, P < 0.05). The oocyte utilization rate in GH+ cycles was remarkably improved, even with older patients and more failed previous attempts. Significant improvement in embryo quality was shown by an increased number of good-quality embryos and improved oocyte utilization rate after matching.

CONCLUSIONS

The longer term use of low-dose GH administration for 6 weeks could be beneficial for the utilization of oocytes and for finally increasing the live birth rates of POR.

摘要

目的

探讨生长激素(GH)预处理6周是否能提高卵巢低反应者(POR)的活产率。

方法

本研究为自我对照的回顾性研究,于2010年10月至2016年4月在中国广州某大学附属医院对380例接受GH辅助治疗(GH+)的POR患者进行。从上次月经开始每日注射生长激素,持续至取卵,约6周。比较每位患者GH+周期与其他无GH(GH-)周期的临床变量。两个周期均采用相似的常规控制性卵巢刺激方案进行体外受精治疗。进行一对一病例对照匹配以调整GH+周期与GH-周期之间的重要混杂因素。

结果

GH预处理显著改善了胚胎质量(1.14±1.50 vs 0.11±0.48,P<0.05)并降低了流产率(18.8% vs 80.0%,P<0.05),从而使活产率提高(23.5% vs 3.9%,P<0.05)。即使是年龄较大且既往尝试失败次数较多的患者,GH+周期的卵母细胞利用率也显著提高。匹配后,优质胚胎数量增加以及卵母细胞利用率提高表明胚胎质量有显著改善。

结论

长期使用低剂量GH 6周可能有利于卵母细胞的利用,并最终提高POR的活产率。

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