目的 探讨第一周期采用降调节长方案行体外受精/卵胞浆内单精子注射胚胎移植(IVF/ICSI ET)未获成功的卵巢正常反应患者,改用高孕激素状态下促排卵(PPOS)方案的临床效果. 方法 回顾性分析2014年1月至2015年11月我科第一周期长方案促排卵后助孕治疗未获成功,第二周期PPOS方案后行冻融胚胎移植(FET)的卵巢正常反应患者共42例,自身对照两种促排卵方案中激素水平、药物使用、获卵及胚胎情况以及PPOS方案后FET的妊娠结局. 结果 PPOS方案中Gn天数[(10.33±2.00) d]、Gn总量[(2 325.00±449.08) U]显著低于长方案[分别为(13.00±2.27)d、(3 182.98±904.91)U](P＜0.05);PPOS方案扳机日血清LH水平[(1.64±1.31)U/L]显著高于长方案[((0.91±1.01)U/L]、孕酮(P)水平[(2.25±0.86) nmol/L]显著低于长方案[(3.87±1.68) nmol/L](P均＜0.05);PPOS方案的平均获卵数、成熟卯母细胞数、正常受精数、可利用胚胎数与长方案比较无显著性差异(P＞0.05),正常受精率[(71.82±17.64)％]、优胚数[(3.62±1.97)枚]和优胚率[(62.21±24.04)％]均显著高于长方案[分别为(63.75±15.77)％、(2.79±1.65)枚、(48.48±22.53)％](P＜0.05).PPOS方案中有3例患者因无冷冻胚胎取消周期;39例患者行FET(共46个周期),22个周期获得临床妊娠,周期临床妊娠率47.83％,种植率24.74％,显著高于长方案[分别为7.02％、3.64％](P＜0.05). 结论 对于长方案促排后助孕未获成功的卵巢正常反应患者,PPOS方案可获得较好的临床妊娠结局,为促排卵治疗提供了一种新的选择方案.%Objective:To explore the clinical effect of progestin primed ovarian stimulation(PPOS) protocol in normal ovarian responders who failed to get pregnancy in the first cycle IVF/ICSI with conventional long protocol.Methods:The data of 42 normal ovarian responders who failed to get pregnancy with long protocol at the first cycle,and then were administrated with PPOS protocol in the next cycle in our center from Jan.2014 to Nov.2015 were analyzed retrospectively.The levels of LH,E2,progesterone on the trigger day,duration and total dosage of gonadotropin(Gn) used,number of oocytes retrieved,MII oocytes,fertilization rate,high quality embryos rate,and implantation rate and clinical pregnancy rate were compared between the two groups.Results:The duration [(10.33 ± 2.00) vs.(13.00 ± 2.27) days] and total dosage of Gn used [(2 325.00±449.08)U vs.(3 182.98±904.91)U] with PPOS protocol were significantly less than those with long protocol(P＜0.05).The LH levels [(1.64± 1.31)U/L vs.(0.91± 1.01) U/L] were significantly higher,and progesterone levels [(2.25 ± 0.86) nmol/L vs.(3.87 ± 1.68) nmol/L)] were significantly lower in PPOS protocol cycles compared with long protocol cycles(P＜0.05).Although the number of oocytes retrieved,MII oocytes,2PN embryos,available embryo were not significantly different (P＞0.05),the fertilization rate [(71.82± 17.64)％ vs.(63.75 ±15.77) ％] and high quality embryos number [(3.62± 1.97) vs.(2.79 ± 1.65)] and rate [(62.21 ± 24.04) ％ vs.(48.48 ± 22.53) ％] were significantly increased in PPOS protocol cycles (P ＜ 0.05).The clinical pregnancy rate (47.83％ vs.7.02％) and implantation rate(24.74％ vs.3.64％) were significantly improved in the FET cycles with PPOS protocol(P＜0.05).Conclusions:PPOS protocol can provide better clinical outcome for the patients with ovarian normal response but failed to get pregnancy with long protocol in IVF/ICSI.It provides a new option for ovulation induction.
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