目的：比较来曲唑（LE）联合尿促性腺激素（HMG）和 LE 联合氯米芬（CC）两种微刺激方案对卵巢储备功能低下患者的助孕结局。方法选择温州医科大学附属第二医院生殖中心2013年3月—2014年4月接受体外受精-胚胎移植的131例不孕患者131个周期的临床资料进行回顾性分析。其中 LE ﹢ HMG 组71个周期（71例），LE ﹢CC 组60个周期（60例）。比较两组一般临床资料及临床结局的差异。结果两组的年龄、不孕年限、HCG 注射日孕酮和雌二醇水平、HCG 注射日直径﹥16 mm 卵泡个数、获卵数、受精率、种植率及流产率比较，差异均无统计学意义（P ﹥0.05）。LE ﹢ HMG 组 HCG 注射日子宫内膜厚度为（8.1±2.0）mm，明显高于 LE ﹢ CC 组的（6.4±1.8）mm（t＝-3.27，P ﹤0.05）；LE ﹢ HMG 组优胚率明显低于 LE ﹢ CC 组（51.7％与75.0％），差异有统计学意义（χ2＝6.60， P ﹤0.05）。LE ﹢ HMG 组临床妊娠率为17.3％，LE ﹢ CC 组临床妊娠率为27.2％，差异无统计学意义（χ2＝4.06，P ﹥0.05）。结论两种微刺激方案对于卵巢储备功能低下患者均有一定效果，但 LE 联合 CC 的治疗方案能获得更优质的胚胎，临床结局可能更好。%Objective To compare the clinical outcome of mild stimulation protocols of letrozole combined with HMG (LE ﹢ HMG)and letrozole combined with clomiphene(LE ﹢ CC)for patients with ovarian insufficiency. Methods Clinical data of 131 cycles from 131 infertile patients who underwent in vitro fertilization - embyo transfer in the Reproductive Center of the Second Hospital Affiliated to Wenzhou Medical University from March 2013 to April 2014 were retrospectively analyzed. The patients were divided into LE ﹢ HMG group(n = 71)and LE ﹢ CC group(n = 60). The differences in clinical data and clinical outcome were compared between the two groups. Results No statistically significant differences were found between the two groups in age,infertility time,progesterone(P)value and E2 value on the day of HCG injection,the number of follicles with diameter ﹥ 16 mm on the day of HCG injection,the number of retrieved oocytes,fertilization rate,implantation rate and abortion rate(P ﹥ 0. 05). The endometrial thickness of patients in LE ﹢ HMG group on the day of HCG injection was(8. 1 ± 2. 0)mm,significantly thicker than that of group LE ﹢ CC which was(6. 4 ± 1. 8)mm(t = - 3. 27,P ﹤ 0. 05);while the good quality embryo rate of LE ﹢ CC group was significantly higher than group LE ﹢ HMG(75. 0% vs. 51. 7% ;χ2 = 6. 60,P ﹤0. 05). The clinical pregnancy rate of LE ﹢ CC group was 27. 2% ,LE ﹢ HMG group was 17. 3% ,there was no statistically significant difference(χ2 = 4. 06,P ﹥ 0. 05). Conclusion The two mild stimulation protocols both have certain efficacy on patients with ovarian insufficiency,while better clinical outcome may be achieved by LE ﹢ CC protocol.
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