Effect of Three Controlled Ovarian Hyperstimulation Protocols in Advanced Women Undergoing in vitro Fertilization and Embryo Transfer_West China Medical Journal

Authors：

WEI Han ,  LI Shangwei , ZENG Xun , LI Xiaohong , LI Xiaoshi

The Reproductive Medical Center, West China Second University Hospital, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Shangwei, Email: weihan_sky@126.com

Keywords：

体外受精-胚胎移植; 控制性超促排卵; 促性腺激素释放激素拮抗剂; 促性腺激素释放激素激动剂

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目的　探讨3种不同助孕方案在≥40岁妇女体外受精-胚胎移植（IVF-ET）周期中的临床效果。方法　回顾性分析2010年8月－2012年2月期间，于四川大学华西第二医院生殖中心行IVF-ET助孕、年龄≥40岁妇女共245个周期的临床资料，排除一侧卵巢缺如患者3例，余242个周期根据助孕方案不同分为3组：拮抗剂组（GnRH-A方案组）44个周期、长方案组109个周期及短方案组89个周期，比较3种方式助孕的临床效果。结果　3组均无早发黄体生成素峰；长方案组应用促性腺激素（Gn）的时间最长，应用Gn数量最多，获得最高的获卵数及获胚数（P＜0.05）；3组的受精率、优胚率、冷冻胚胎数、周期取消率、卵巢过度刺激综合征发生率、早期流产率均无统计学意义（P＞0.05），短方案组的种植率及临床妊娠率最低（P＜0.05）。结论　GnRH-a长方案在≥40岁妇女的IVF-ET周期中具有较好的临床结局，在≥40岁妇女IVF-ET周期中具有与长方案相似的结局，并且可以减少Gn使用量，提高卵泡及胚胎质量，短方案组对≥40岁妇女临床效果较差。

Citation： WEI Han,LI Shangwei,ZENG Xun,LI Xiaohong,LI Xiaoshi. Effect of Three Controlled Ovarian Hyperstimulation Protocols in Advanced Women Undergoing in vitro Fertilization and Embryo Transfer. West China Medical Journal, 2012, 27(12): 1855-1858. doi: Copy

1.	Tsafrir A, Simon A, Margalioth EJ, et al. What should be the first-line treatment for unexplained infertility in women over 40 years of age ovulation induction and IUI, or IVF[J]. Reproductive Bio Medicine Online，2009, 19(Suppl 4): 47-56.
2.	肖劲松, 陈双陨, 张春莲, 等. 促性腺激素释放激素拮抗剂在体外受精-胚胎移植中有效性的系统性评价[J]. 中国循证医学杂志, 2010, 10(12): 1432-1438.
3.	肖劲松, 陈双陨, 张春莲, 等. GnRH-拮抗剂对体外受精-胚胎移植中低反应患者有效性的系统性评价现代妇产科进展[J]. 现代妇产科进展, 2011, 20(4): 300-306.
4.	Veek LL. The morphological assessment of human oocytes and early concpti. In: Keel BA , Webster BW editors.Hand-book of the Laboratory Diagnosis and Treatment of Infertility[C]. Boca Raton FL: CRC Press, 1990: 353-369.
5.	何钻玉, 李琳, 陈晓莉, 等. 不同年龄段不孕患者控制性超排卵中卵巢低反应的预测[J]. 中国妇产科临床杂志, 2011, 12(6): 410-413.
6.	Serour G, Mansour R, Serour A, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above[J]. Fertil Steril, 2010, 94(5): 1707-1712.
7.	Klipstein S, Regan M, Ryley DA, et al. One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above[J]. Fertil Steril, 2005, 84(2): 435-445.
8.	Ng EH, Ho PC. Ageing and ART: a waste of time and money?[J]. Best Pract Res Clin Obstet Gynaecol, 2007, 21(1): 5-20.
9.	Tsafrir A, Simon A, Revel A, et al. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older[J]. Reproductive BioMedicine Online, 2007,14(3): 348-355.
10.	Avrech OM, Orvieto R, Pinkas H, et al. Inclusion of standard and low-dose gonadotropin releasing hormone-analog (short protocol) in controlled ovarian hyperstimulation regimens in normogonadotropic patients aged 40-48 years who are undergoing in vitro fertilization[J]. Gynecol Endocrinol, 2004, 19(5): 247-252.
11.	王乐乐, 陈士岭, 陈薪, 等. 高龄妇女体外受精-胚胎移植治疗周期的临床特征和治疗结局分析[J]. 中国优生与遗传杂志, 2011, 19(5): 105-107.
12.	Huirne JA, van Loenen AC, Schats R, et al. Dose-finding study of daily gonadotropin-releasing hormone (GnRH) antagonist for the prevention of premature luteinizing hormone surges in IVF/ICSI patients: antide and hormone levels[J]. Hum Reprod, 2004, 19(10): 2206-2215.
13.	Sbracia M, Colabianchi J, Giallonardo A, et al. Cetrorelix protocol versus gonadotropin-releasing hormone analog suppression long protocol for superovulation in intracytoplasmic sperm injection patients older than 40[J]. Fertility and Sterility, 2009, 91(5): 1842-1847.
14.	Lubna Pal, Sangita J, Barry R, et al. Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization[J]. Fertility and Sterility, 2008, 89(6): 1694-1701.
15.	Amir W, Micha B, Ariel H, et al. Predicting factors for endometrial thickness during treatment with assisted reproductive technology[J]. Fertility and Sterility, 2007, 87(4): 799-804.

1. 　Tsafrir A, Simon A, Margalioth EJ, et al. What should be the first-line treatment for unexplained infertility in women over 40 years of age ovulation induction and IUI, or IVF[J]. Reproductive Bio Medicine Online，2009, 19(Suppl 4): 47-56.
2. 　肖劲松, 陈双陨, 张春莲, 等. 促性腺激素释放激素拮抗剂在体外受精-胚胎移植中有效性的系统性评价[J]. 中国循证医学杂志, 2010, 10(12): 1432-1438.
3. 　肖劲松, 陈双陨, 张春莲, 等. GnRH-拮抗剂对体外受精-胚胎移植中低反应患者有效性的系统性评价现代妇产科进展[J]. 现代妇产科进展, 2011, 20(4): 300-306.
4. 　Veek LL. The morphological assessment of human oocytes and early concpti. In: Keel BA , Webster BW editors.Hand-book of the Laboratory Diagnosis and Treatment of Infertility[C]. Boca Raton FL: CRC Press, 1990: 353-369.
5. 　何钻玉, 李琳, 陈晓莉, 等. 不同年龄段不孕患者控制性超排卵中卵巢低反应的预测[J]. 中国妇产科临床杂志, 2011, 12(6): 410-413.
6. 　Serour G, Mansour R, Serour A, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above[J]. Fertil Steril, 2010, 94(5): 1707-1712.
7. 　Klipstein S, Regan M, Ryley DA, et al. One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above[J]. Fertil Steril, 2005, 84(2): 435-445.
8. 　Ng EH, Ho PC. Ageing and ART: a waste of time and money?[J]. Best Pract Res Clin Obstet Gynaecol, 2007, 21(1): 5-20.
9. 　Tsafrir A, Simon A, Revel A, et al. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older[J]. Reproductive BioMedicine Online, 2007,14(3): 348-355.
10. 　Avrech OM, Orvieto R, Pinkas H, et al. Inclusion of standard and low-dose gonadotropin releasing hormone-analog (short protocol) in controlled ovarian hyperstimulation regimens in normogonadotropic patients aged 40-48 years who are undergoing in vitro fertilization[J]. Gynecol Endocrinol, 2004, 19(5): 247-252.
11. 　王乐乐, 陈士岭, 陈薪, 等. 高龄妇女体外受精-胚胎移植治疗周期的临床特征和治疗结局分析[J]. 中国优生与遗传杂志, 2011, 19(5): 105-107.
12. 　Huirne JA, van Loenen AC, Schats R, et al. Dose-finding study of daily gonadotropin-releasing hormone (GnRH) antagonist for the prevention of premature luteinizing hormone surges in IVF/ICSI patients: antide and hormone levels[J]. Hum Reprod, 2004, 19(10): 2206-2215.
13. 　Sbracia M, Colabianchi J, Giallonardo A, et al. Cetrorelix protocol versus gonadotropin-releasing hormone analog suppression long protocol for superovulation in intracytoplasmic sperm injection patients older than 40[J]. Fertility and Sterility, 2009, 91(5): 1842-1847.
14. 　Lubna Pal, Sangita J, Barry R, et al. Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization[J]. Fertility and Sterility, 2008, 89(6): 1694-1701.
15. 　Amir W, Micha B, Ariel H, et al. Predicting factors for endometrial thickness during treatment with assisted reproductive technology[J]. Fertility and Sterility, 2007, 87(4): 799-804.

West China Medical Journal

Effect of Three Controlled Ovarian Hyperstimulation Protocols in Advanced Women Undergoing in vitro Fertilization and Embryo Transfer

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