卵巢低反应患者口服避孕药、雌激素预治疗对IVF-ET影响的比较研究

目的:比较卵巢低反应患者采用口服避孕药、口服避孕药和雌激素序贯法、单独使用雌激素3种预治疗方案对体外受精-胚胎移植(IVF-ET)的影响。方法:A组对象月经周期第3天开始口服妈富隆,1片/d,持续21d;B组对象月经周期第3天口服妈富隆,1片/d,21d后改为口服补佳乐,2mg/d;C组对象黄体中期开始口服补佳乐,4mg/d;每组均在使用后撤退出血第3天短方案降调,并同时开始超促排卵治疗,比较相关指标。结果:IVF-ET启动日患者基础卵泡刺激素(FSH)水平均降至10U/L以下,预治疗后第3日及hCG日E2水平3组无差异(P>0.05)。hCG日子宫内膜厚度C组高于A、B组;A组周期取消数高于B、C组;A、B组促性腺激素使用时间长于C组,C组妊娠率高于A组与B组(均P<0.05);获卵数,MII卵子数,移植胚胎数差异无统计学意义。结论:对卵巢低反应者,在IVF-ET周期之前给予口服避孕药、雌激素预治疗方案中,黄体中期给予口服补佳乐(4mg/d)的治疗效果最佳。

Pretreatment effects of oral contraceptive pill and estrogen on the outcome of in vitro fertilization- embryo transfer in poor responders

Objective： To compare pretreatment effects of oral contraceptive pills, oral contraceptive pills followed by estrogen and estrogen alone on the outcome of in vitro fertilization - embryo transfer（ IVF - ET） in poor responders. Methods ： Women in group A were administered with Marvelon daily from day 3 of menstrual cycle for 21 days. Women in group B were adminis- tered with Marvelon daily from day 3 of menstrual cycle for 21 days, followed by 2mg of estrogen daily. Women in group C were administered with 4mg of estrogen daily from middle luteal phase. Ovarian stimulation began on day 3 with a short proto- col. Indicators relevant to IVF - ET were evaluated. Results ： All pretreatment proposals reduced the level of basal follicle stimu- lating hormone to less than 10 U/L on the first day of ovarian stimulation. There were no significant differences in serum estrodiol concentration on day 3 and the day of human chorionic gonadotropin（HCG） administration between three groups （P 〉 0.05 ）. The endometrium thickness of women in group C was significantly higher than those of group A and group B on the day of HCG administration . The rate of cycle cancellation in group A was the highest. Women in group C resulted in the shortest Gn time and the highest pregnancy rate （ P all 〈 0.05 ）. There were no significant differences in the number of retrieved oocytes, the number of MII oocytes and the number of embryos. Conclusion ： For poor responders, pretreatment with oral contraceptives followed by 4mg of estrogen daily from the middle luteal phase prior to IVF - ET cycle could be an optimal protocol.