CAJ | 학술논문

目的：探讨高反应患者在体外受精-胚胎移植（IVF-ET）中行重复周期垂体降调节长方案，调整治疗策略对卵巢反应性及妊娠结局的影响。方法选择南方医院生殖医学中心2008年1月~2011年12月30例高反应患者60个长方案行IVF-ET治疗不孕症的周期进行回顾性分析，比较高反应患者前后周期治疗的临床特点。结果与第一治疗周期相比，患者行重复周期治疗时年龄明显增加（P<0.001），Gn启动剂量明显减少（P=0.049），hCG日雌激素（E2）水平降低（P=0.027），获卵数减少（P=0.030），优质胚胎形成率（P<0.001）、临床妊娠率（P=0.009）升高，但在降调节剂量、Gn应用总量、Gn刺激时间、2原核（PN）个数、受精数、卵巢过度刺激综合征（OHSS）高危倾向周期取消率无显著性差异（P>0.05），再次发生卵巢高反应者占40%（12/30）。结论对于高反应患者，行长方案重复IVF周期治疗时应注意减小Gn启动剂量，减少再次发生高反应的风险，改善助孕结局。
목적：탐토고반응환자재체외수정-배태이식（IVF-ET）중행중복주기수체강조절장방안，조정치료책략대란소반응성급임신결국적영향。방법선택남방의원생식의학중심2008년1월~2011년12월30례고반응환자60개장방안행IVF-ET치료불잉증적주기진행회고성분석，비교고반응환자전후주기치료적림상특점。결과여제일치료주기상비，환자행중복주기치료시년령명현증가（P<0.001），Gn계동제량명현감소（P=0.049），hCG일자격소（E2）수평강저（P=0.027），획란수감소（P=0.030），우질배태형성솔（P<0.001）、림상임신솔（P=0.009）승고，단재강조절제량、Gn응용총량、Gn자격시간、2원핵（PN）개수、수정수、란소과도자격종합정（OHSS）고위경향주기취소솔무현저성차이（P>0.05），재차발생란소고반응자점40%（12/30）。결론대우고반응환자，행장방안중복IVF주기치료시응주의감소Gn계동제량，감소재차발생고반응적풍험，개선조잉결국。
Objective To evaluate the ovarian response and pregnancy outcomes in patients with excessive ovarian response receiving long-protocol pituitary down-regulation during repeated in vitro fertilization and embryo transfer (IVF-ET). Methods Sixty IVF-ET cycles from January 2008 to December 2011 were analyzed retrospectively. The clinical characteristics were compared between the various treatment cycles. Results Compared with those with the first treatment cycle, the patients receiving repeated cycles had a significantly older age (P<0.001), reduced initial doses of Gn (P=0.049), and moderately lowered estrogen level on the day of hCG administration (E2) (P=0.027) and the number of oocytes retrieved (P=0.030). The high-quality embryo formation rate (P<0.001) and clinical pregnancy rate (P=0.009) were both significantly higher in patients with repeated cycles. The dose for down-regulation, total Gn dose, duration of Gn stimulation, number of two pronuclei (PN), number of fertilized oocyte, and the cancellation rate for a high risk of ovarian hyperstimulation syndrome (OHSS) were all comparable between the two groups (P>0.05). The recurrence rate of ovarian excessive respond was 40%(12/30). Conclusion For patients receiving repeated IVF treatment cycle with a high ovarian response, a smaller initial dose of Gn should be used to minimize the risk of hyper-response and improve the outcome of assisted reproductive treatment.