反复控制性卵巢刺激对卵巢功能状态的影响

 【目的】评价在辅助生育技术治疗中反复控制性卵巢刺激对卵巢功能的影响。【方法】 回顾性分析1994年3月至2005年5月就诊于本中心接受IVF治疗行控制性卵巢刺激（COH）≥4个治疗周期的127例患者的病历资料（共508个周期），比较多次COH后基础激素水平的变化，以及不同治疗周期患者的取卵数和促性腺激素（Gn）的使用剂量，统计学方法采用t检验和重复测量资料的方差分析，P<0.05被认为有统计学意义。【结果】随着COH治疗周期数的增加，患者的年龄逐渐增加，比较各周期患者月经第3天FSH、LH、PRL、E2 、T的基础值，各激素水平之间并无统计学意义 (P=0.25~0.93)。与首次接受促超排卵周期相比较，促性腺激素（Gn）的使用剂量在第3、4、5、6、7、8治疗周期显著增加(P=0.0001~0.0084)，但是各周期患者取卵数并无统计学意义(P=0.21~0.61),在对年龄分组后比较各周期Gn的使用剂量也无统计学差异(P=0.12~0.94)。本研究还对一直在本院接受COH治疗≥7个周期的12名例患者进行自身对照的比较，发现随着COH周期数的增加，患者的Gn使用剂量也增加，但控制年龄因素的作用后，Gn的使用剂量则无统计学差异（P=0.13）。【结论】反复的COH治疗不会影响卵巢的储备功能, 接受多个周期COH治疗后的患者Gn使用剂量的增加是由于年龄因素所导致的。

Influence of Repeated Controlled Ovarian Hyperstimulation on Ovarian State

Objective] To assess the effect of repeated controlled ovarian hyperstimulation (COH) and puncture on the ovarian state in the patients treated with assisted reproduction techniques (ARTs). Methods] Our research was conducted by retrospective analysis of the data between March 1994 and May 2005 from the 127 patients (508 cycles) who received at least four COH cycles in our center. We compared the basal sexual hormones after repeated COH in treatment of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), the dosage of gonadotropin (Gn), as well as the oocytes retrieved number. Results] As the COH cycle increased and patient aged, there were no significant differences in the basal serum level of follicle stimulating hormone (FSH), luteinizing hormone (LH), estrodial (E2), prolactin (PRL), and testosterone (T) between different cycles (P=0.25-0.93). When compared with the patient in the first cycle, gonadotropin dosage significantly climbed up in the 3rd, 4th, 5th, 6th, 7th, and 8th cycles (P=0.0001-0.0084), no statistic difference in retrieved oocyte number(P=0.21-0.61), but after the patients were divided into different age groups no significant difference was found in the same age group (P=0.12-0.94). Besides that we compared 12 patients who received COH cycle in our center all the time, it was found that the Gn dosage was increased as patient aged; however, those differences disappeared after age was controlled (P=0.13). Conclusions] Repeated controlled ovarian stimulation does not affect ovarian reserved function. The increasing of Gn dosage was caused by patient aging.