黄体期雌激素预处理对卵巢低反应患者拮抗剂方案体外受精－胚胎移植治疗结局的影响
Effects of estradiol pretreatment at luteal phase on outcome of in vitro fertilization and embryo transfer treatment of antagonist protocol for patients with poor ovarian responder

目的 探讨黄体期雌激素预处理对卵巢低反应患者拮抗剂方案体外受精－胚胎移植（IVF-ET）治疗结局的影响。方法 回顾性分析173例接受IVF-ET治疗的卵巢低反应患者，按超促排卵前是否行雌激素预处理（黄体期戊酸雌二醇4 mg/d口服至月经第2日）分为预处理组（n＝96）和未处理组（n＝77），比较两组一般情况及IVF-ET治疗结局相关指标。 结果 两组患者的年龄（P=0.857）、体质量指数（BMI）（P=0.727）、血基础促卵泡激素（FSH）（P=0.926）/促黄体生成素（LH）（P=0.579）/雌二醇（E2）值（P=0.898）、窦卵泡计数（AFC）（P=0.662）、移植日子宫内膜厚度（P=0.542）和移植胚胎数（P=0.321）比较，差异均无统计学意义。与未处理组比较，预处理组超促排卵治疗前血FSH（P=0.000）和LH（P=0.019）水平显著降低，窦卵泡平均直径显著减小（P=0.000），治疗中促性腺激素治疗总量（P=0.001）和使用天数（P=0.001）明显增加，绒毛膜促性腺激素（HCG）日E2（P=0.000）和LH（P=0.000）水平升高；预处理组的获卵数（P=0.001）和可用胚胎数（P=0.005）高于未处理组，但两组间的受精率（P=0.648）、优质胚胎率（P=0.172）、种植率（P=0.845）、临床妊娠率（P=0.948）和继续妊娠率（P=0.899）比较,差异无统计学意义。结论 黄体期雌激素预处理可增加IVF-ET治疗中卵巢低反应患者拮抗剂方案的获卵数和可用胚胎数。
： Objective To explore the effects of estradiol pretreatment at the luteal phase on the outcome of in vitro fertilization and embryo transfer (IVF-ET) treatment of antagonist protocol for patients with poor ovarian responder. Methods Data of 173 patients with poor ovarian response who have underwent IVF-ET treatment were retrospectively analyzed. Patients were divided into the pretreatment group (n=96) and non-pretreatment group (n=77) according to whether the estradiol pretreatment (oral administration with 17 β-estradiol for 4 mg/d at the luteal phase till the second day of menstrual cycle) were conducted before super ovulation induction. General information and indexes relevant to the outcome of IVF-ET treatment of two groups were compared. Results The differences of age (P=0.857), BMI (P=0.727), basal serum FSH (P=0.926)/LH (P=0.579)/E2 value (P=0.898), basal antral follicle count (AFC) (P=0.662), endometrial thickness (P=0.542) and the number of embryos transferred (P=0.321) on transfer day between the two groups were not statistically significant. Compared with the non-pretreatment group, blood FSH (P=0.000) and LH (P=0.019) levels of the pretreatment group before super ovulation induction significantly decreased, mean antral follicle sizes significantly decreased (P=0.000), the total amount of gonadotropin (P=0.001) and stimulation period (P=0.001) significantly increased, and HCG daily E2 (P=0.000) and LH level (P=0.000) increased. The number of retrieved oocytes (P=0.001) and obtained embryos (P=0.005) of the pretreatment group was larger than that of the non-pretreatment group, while the differences of fertilization rate (P=0.648), high-quality embryo rate (P=0.172), implantation rate (P=0.845), clinical pregnancy rate (P=0.948), and continued pregnancy rate (P=0.899) between two groups were not statistically significant. Conclusion Estradiol pretreatment at the luteal phase can