| According to statistics, the incidence of infertility is 15%~20% in foreign countries,there is about 5% in China. Since 1978, with the born of the world’s first test-tube baby, IVF- ET makes the infertility increase pregnancy rate with the help of assisted reproductive technology, and the technology has brought the hope for infertility family. However, with the quickly development of assisted reproductive technology, there are more and more super stimulating ovulation schemes,how to select the best scheme of stimulate ovulation in access to get the high quality of eggs and embryos, raise clinical pregnancy rate, and reduce the incidence of complications, at the same time obtain good pregnancy outcomes, which is a goodwill for the family of infertility. According to the reasons for the patients with infertility and economic condition, social factors make optimization on the patients and the most economic treatment, is one of the focus problems the clinicians to face. Micro stimulation ovulation is refers to in the case of not adjust pituitary drop, the gonadal hormones stimulate ovulation for in vitro fertilization- embryo transfer(IVF/ICSI- ET) a treatment plan, because of its advantages of safety, high efficiency, less interference, gradually accepted by people in recent years. In recent years, micro stimulation ovulation scheme was used usually, ovarian infertility patients of low reaction, according to the results of this stimulate ovulation scheme can effectively improve the pregnancy rate, the scheme can stimulate ovulation scheme as a line in the ovarian reserve function in patients with normal, no opinion. This study is in order to investigate the application of micro stimulation ovulation scheme used in patients with normal ovarian reserve,at the same time Gn RH- a long plan as a comparison.Objective: To investigate the application of micro stimulation ovulation for patients with normal ovarian reserve that underwent IVF/ICSI-ET. Methods:1 Retrospectively analyzed 200 patients who were diagnosed with normal ovarian reserve and underwent IVF/ICSI-ET in the ART Department of the Baiqiuen International Peace Hospital from April 2013 to October 2014. According to different administration,they were divieded into two groups randomly:treatment group(micro-stimulation group,n=98) and control group(Gn RH-a stimulation ovulation gruop,long-stimulation group,n=102). Inclusion criteria:(1)Aged between 20 and 36;(2) Basic AFC is from 8 to 20;(3)Basic serum FSH < 10 m IU/ml,(4) Basic serum E2<50 pg/ml; At the same time, eliminate diseases such asendometriosis, uterine fibroids.2 The treatment group: The patients would take the LE 25 mg everyday sincethe third day of menstruation for five days and were given the HMG injection every day at the same time, the eighth day of menstruation take CC and given the HMG injection every day at the same time, when the number of ovarian follicle in the ultrasound which diameter was 18 mm and the number of ovarian follicle which diameter was 14 mm is over 60%, Gn RH-a 0.2 mg were given on the evening and indometacin 50 mg rectum given for every 8 hours. To take eggs under transvaginal ultrasound after after 35-36 hours.Give conventional in vitro fertilization or follicle fertilization intracytoplasmic sperm injection after taking eggs and take embryo transplant according to the quality and quantity after 48-72 hours. We will know the clinical pregnancies under ultrasound after 4 weeks.3 The control group: The paients were given gonadorelin subcutaneous injection Qu Pu gonadorelin 0.1mg every day which can adjust the drop in the middle of the cycle before treatment of corpus luteum, when achieve drop standard regulation giving Gn to stimulate ovulation. When achieving the standard of taking eggs,the patients were given HCG 6500 iu injection in the evening and take eggs after 35-36 hours.The other process was same to the former group.4 The comparison of two groups of the days of Gn, the dosage of Gn, the day of HCG injection intrauterine membrane thickness, serum E2 level, serum P level, serum LH level, > 16 mm average number of follicles, egg number, average M number and average number of fertilized eggs, average number Ⅱof 2PN, fertilization rate, high quality embryo rate, available embryo rate,frozen embryos periodicity rate, implantation rate, clinical pregnancy rate and other indicators.Calculate the sum of patients with serum LH level was over 10 m IU/ml before the day of HCG injection in two groups. Compared the fertilization rate, clinical pregn ancy rate and impantion rate between the patients with serum LH level was over 10 m IU/ml and the patients with serum LH level was lower 10 m IU/ml.5 Statistical methods: Datas were analyzed by SPSS17.0 statistical soft ware packet, and datas were expressed as mean±standard deviation. The significance difference in two groups was determined using t inspection and chi-square inspection. When P<0.05,comparison was considered significant. Results: There were no significant differences in stimulate ovulation on the days of Gn, gonadotropin doses, endometrial thickness on the day of injection of HCG, frozen embryos periodicity, implantation rate, clinical pregnancy rate(P>0.05); There were significant differences in two groups on the day of HCG injection,serum E2 values in treatment group were lower than those in control group, the difference was statistically significant(3595.5±2740.02 vs5565.78±2936.33, P<0.05); the average number of follicles(>16mm) in treatment group is lower than the control group, the difference was statistically significant(12.13±1.56vs14.87±2.31, P<0.05); serum P value in the treatment group were higher than in control group, difference was statistically significant(1.93±1.02vs1.12± 0.53, P<0.05); serum LH values in treatment group were higher than the control group, the difference was statistically significant(5.57±3.40vs1.13±0.65, P<0.05); Average number of eggs in the treatment group was lower than the control group, the difference was statistically significant(12.33±6.29vs14.75±7.13, P<0.05); The average fertility rate in treatment group was lower than the control group, the difference was statistically significant(9.28 ±4.98vs11.17±5.76, P<0.05); The average number of M in treatment group was lower than in control group, Ⅱthe difference was statistically significant(10.81±5.94vs13.80±6.67, P< 0.05);The optimal embryo rate in treatment group was obviously higher than in control group, the difference was statistically significant(52% vs42.1%, P<0.05), the available embryo rate in treatment group was obviously higher than that of control group, the difference was statistically significant(80.3% vs70.4 %, P< 0.05); there were 6(5.8%) OHSS patients in control group,while there was no OHSS occured.There were nine patients who had higher serum luteotrophic hormone(LH)level(LH>10 m IU/ml) before the day of HCG injection in treatment group. Group S1 and group S2 were divided in treatment group,the datas were compared in group S1 and group S2.There was no statistical significance between two group,fertilization rate(91.4% vs93.1%,P<0.05), pregnancy rate(60.0%vs58.3%,P<0.05), planting rate(30.0%vs33.7%,P<0.05). Compared with the conventional stimulation protocol, micro-stimulation protocol does not reduce the clinical pregnancy rate after embryo transfer in fresh cycle, there were no significance on implantation rate, clinical pregnancy rate in two groups(51.7%vs54.5%,P< 0.05).Conclusions:1 For the patients with normal ovarian reserve,who will undergo IVF/ICSI, micro stimulation ovulation is one of effective scheme,which has no adjusting process, less Gn consumptions, relative cheaper costs and does not affect outcome of IVF/ICSI-ET,so micro stimulation ovulation is worthy of applicating in clinical widely.2 Micro stimulation ovulation for patients with normal ovarian reserve can be based on conventional standards for fresh embryo transfer, does not affect the outcome of pregnancy. |
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