目的：比较高龄不孕女性体外受精／卵胞质内单精子显微注射一胚胎移植（IVF／ICSI-ET）中微量短效GnRH-a长方案及常规短方案的促排卵效果及临床结局。方法：回顾性分析602例≥35岁不孕患者682个周期IVF／ICSI-ET临床结局，按促排卵方案分为微量短效GnRH-a长方案组（172个周期，A组）和常规短方案组（510个周期，B组），再以年龄段分层（35～37岁，38～39岁及≥40岁），分别比较不同年龄段两种促排卵方案的效果及临床结局。结果：A组Gn用量、Gn使用天数显著高于B组（P〈0．05），MⅡ卵数、优质胚胎率、胚胎移植数、周期取消率均无统计学差异（P〉0．05）；A组与B组相比，临床妊娠率、活产率（36．1％坩29．8％；28．5％vs 23．3％；P〉0．05）有改善趋势；尤其在35～37岁及38～39岁患者中，A组优质胚胎率、临床妊娠率、活产率（52．89％vs 47．16％，50．14％ vs 47．97％；41．7％ vs 36．7％，36．4％ vs 22．2％；35．0％ vs 29．2％，24．2％ vs 15．7％；P均〉0．05）均有明显改善趋势。结论：≥35岁不孕女性微量GnRH-a长方案临床结局有改善趋势，可作为高龄不孕女性，尤其是35～39岁不孕患者的有效促排卵方案之一。
Objective To investigate the correlation between gynaecologic adnexal surgery history and pregnancy outcome of in vitro fertilization （IVF） treatment. Methods A total of 810 women who were proceeded 810 IVF; treatment cycles from October 2009 to March 2011 were recruited to this retrospective study, based on whether they had history of gynaecologic adnexal surgeries or not. Among 810 women, 587 women had no gynaecologic adnexal surgeries （group A）, 223 women had gynaecologic adnexal surgeries （group B）. Additionally, the group B was further divided into 4 subgroups based on their different gynaecologic adnexal surgery histories, such as tubal conservative surgery （group Bal）, unilateral salpingectomy （group Ba2）, ovarian cyst ablation （group Bbl） and unilateral adnexal resection （group Bb2）. The basal levels of FSH, antral follicle count （AFC）, clinical pregnancy rate （CPR）, embryos implantation rates （IR） and live birth rates （LBR） were compared.Results The levels of FSH and AFC were significantly different between groups A and B, respectively. Therefore, CPR, IR and LBR were significantly lower （P 〈0.05） in group B （30.9%, 17.8% and 25.1%） compared with group A （39.9%, 22.8% and 32.4%）. Meanwhile, there was no significant difference between the patients who had tubal conservation surgery （group Bal） and who had unilateral salpingectomy （group Ba2）. However, in contrast to unilateral adnexectomy, ovarian cystectomy surgery influenced FSH and AFC significant, even for the number of oocyte retrieved, but did not affect the IVF treatment outcome. Conclusion The previous history of gynaecologic adnexal surgeries may affect the subsequent ovarian function and also IVF outcomes. As for different operation methods, between tubal conservation surgery and unilateral salpingectomy, the IVF outcomes were not significantly different. The same result we found in different ovarian operation groups.
Yao WANGYun SUNXiao-ming ZHAOSu-ping FANGNing YAOYan HONG
