来曲唑和氯米芬在卵巢低反应患者PPOS中促排卵的疗效比较

Comparison of the Efficacy of Letrozole and Clomiphene in Promoting Ovulation in PPOS Inpatients with Poor Ovarian Response

关键词:  高孕激素状态下促排卵  卵巢低反应  来曲唑  氯米芬

Key words:  progestin-primed ovarian stimulation  poor ovarian response  letrozole  clomiphene

摘要:

目的 比较高孕激素状态下促排卵方案（progestin-primed ovarian stimulation，PPOS）中分别添加来曲唑（letrozole，LE）和氯米芬（clomiphene，CC）在卵巢低反应（poor ovarian response，POR）患者中的胚胎实验室指标及妊娠结局。方法 回顾性分析2015年11月-2018年7月于温州医科大学附属第二医院生殖中心接受体外受精或卵细胞浆内单精子注射助孕治疗的POR患者，并采用PPOS方案共544个周期，根据添加CC或LE分为2组：A组（CC，357周期），B组（LE，187周期），比较2组间胚胎实验室指标和妊娠结局。结果 B组扳机日雌激素水平明显低于A组（P<0.05），但扳机日促黄体生成素水平、孕酮水平无统计学意义；2组间可用卵数、成熟卵数、卵裂数、优质胚胎数、优质胚胎率、卵子成熟度、胚胎利用率、卵子利用率、正常受精数等胚胎实验室指标差异均无统计学意义；此外，2组间临床妊娠率、生化妊娠率、流产率等妊娠结局均无统计学差异。结论 POR患者PPOS方案中分别添加LE与CC的疗效相当，可为临床医师用药提供新思路。

Abstract:

OBJECTIVE To compare the embryo laboratory and pregnancy outcomes between letrozole(LE) and clomiphene(CC) under progestin-primed ovarian stimulation(PPOS) in the patients with poor ovarian response(POR). METHODS A retrospective analysis was implemented among the POR patients who received PPOS and in vitro fertilization or intracytoplasmic sperm injection for pregnancy treatment in the reproductive center, the Second Affiliated Hospital of Wenzhou Medical University in November 2015 to July 2018. With a total of 544 cycles of PPOS, they were divided to group A(CC, 357 cycles) and group B(LE, 187 cycles) according to add CC or LE. The embryo laboratory and pregnancy outcomes were compared and analyzed between the two groups. RESULTS The estrogen level in group B was significantly lower than that in group A(P<0.05), but there was no significant difference in luteinizing hormone level and progesterone level on the trigger day. There were no significant differences in embryonic laboratory indexes such as available eggs number, mature egg number, number of cleavage, high quality embryo number, high quality embryo rate, egg maturity, embryo utilization rate, egg utilization rate and normal fertilization number, et al. The pregnancy outcomes such as clinical pregnancy rate, biochemical pregnancy rate and abortion rate were no significant difference between the groups. CONCLUSION The efficacy of adding LE or CC in the PPOS program of POR patients is equivalent, which can provide new insights for clinicians.