【摘要】 目的 比较卵巢低反应（POR）患者自然周期取卵或排卵后黄体期促排卵的体外受精/卵细胞质内单精子注射（IVF/ICSI）的临床结局。方法 选择采用黄体期促排卵方案行IVF/ICSI助孕的POR患者418例，根据是否实施自然周期取卵分为两组，其中自然周期取卵后行黄体期促排卵169例为A组、自然周期排卵后行黄体期促排卵249例为B组。比较两组黄体期促排卵的获卵数、成熟卵子数、双原核（2PN）受精数、冷冻囊胚（简称冻胚）数、发育天数为第5天的囊胚（D5囊胚）数，以及未获卵周期、无囊胚形成周期的占比；记录A组自然周期的获卵率、获冻胚率及自然周期和黄体期促排卵两次取卵的总获卵数、总冻胚数；比较两组黄体期促排卵使用促性腺激素（Gn）天数、Gn总量及首次移植黄体期促排卵所获冻胚的生化妊娠率、临床妊娠率、早期流产率、活产率。结果 A组黄体期促排卵的获卵数、成熟卵子数、2PN受精数、冻胚数均低于B组，无囊胚形成周期占比高于B组（P均<0.05）。A、B组黄体期促排卵的D5囊胚数、未获卵周期占比比较P均>0.05。A组自然周期获卵率为72.78%(123/169)，均为1枚；自然周期获冻胚率为22.49%(38/169)，均为1枚；A组总获卵数4(3,7)个、总获冻胚数2(1,3)个，B组分别为5(3,8)、2(1,3)个，两组比较P均>0.05。A、B组使用Gn天数、Gn总量及首次移植黄体期促排卵所获冻胚的生化妊娠率、临床妊娠率、早期流产率、活产率比较P均>0.05。结论 自然周期取卵、排卵的POR患者整体上获卵获胚情况、黄体期促排卵后的胚胎质量及IVF/ICSI结局是相近的，但自然周期排卵的POR患者在后续黄体期促排卵阶段有更多的获卵及获胚。更多还原

【Abstract】 Objective To compare the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI) of luteal-phase stimulation after oocyte retrieval in natural cycle or natural ovulation in poor ovarian respond-ers. Methods Totally 418 poor ovarian response patients who underwent IVF/ICSI with luteal-phase stimulation were se-lected. They were divided into two groups based on whether the dominant follicle in the natural cycle was retrievaled or not. Among them, 169 cases underwent luteal-phase stimulation after oocyte retrieval in natural cycle(Group A), and 249 cases underwent luteal-phase stimulation after natural ovulation(Group B). We compared the numbers of oocytes re-trieved, mature oocytes, 2 pronuclcus(2PN) fertilizations, frozen blastocysts, blastocysts of development on the 5th day(D5 blastocysts), and the proportions of non-oocyte and non-frozen blastocyst between the two groups with luteal-phase stimulation. We recorded the oocyte retrieval rate and blastocyst frozen rate of natural cycle, and the total numbers of oo-cytes retrieved and frozen blastocysts obtained from the natural cycle and luteal-phase stimulation in the Group A. We com-pared the days of stimulation and total additional doses of gonadotropin(Gn) of luteal-phase stimulation, and the biochemical pregnancy rate, clinical pregnancy rate, early miscarriage rate, live birth rate of the first transplantation of frozen blas-tocyst which was obtained from the luteal-phase stimulation between the two groups. Results Compared with Group A, the Group B had significantly larger numbers of oocytes retrieved, mature oocytes, 2PN fertilizations, and frozen blasto-cysts with luteal-phase stimulation(all P<0. 05); the proportion of non-frozen blastocyst with luteal-phase stimulation in the Group A was significantly higher than that in the Group B(P<0. 05). There were no significant differences in the num-bers of D5 blastocysts or the proportions of non-oocyte with luteal-phase stimulation between the Group A and Group B(all P>0. 05). In the Group A, the oocyte retrieval rate of natural cycle was 72. 78%(123/169), with an average of one oo-cyte retrieved per case; the blastocyst frozen rate of natural cycle was 22. 49%(38/169), and all cases obtained one fro-zen blastocyst each. The total number of Group A of oocytes retrieved was 4(3, 7) and the total number of frozen blasto-cysts was 2(1, 3), while the numbers of Group B were 5(3, 8) and 2(1, 3), with no significant difference(all P>0. 05). No significant differences were found in the days of stimulation, total additional doses of Gn, the biochemical preg-nancy rate, clinical pregnancy rate, early miscarriage rate, or live birth rate of the first transplantation of frozen blastocyst which was obtained from the luteal-phase stimulation(all P>0. 05). Conclusions The overall numbers of oocytes re-trieved and frozen blastocysts of poor ovarian responders with oocyte retrieval in natural cycle and natural ovulation are sim-ilar, as well as the embryo quality and the IVF/ICSI outcomes of the subsequent luteal-phase stimulation. However, there are larger numbers of oocytes retrieved and frozen blastocysts of luteal-phase stimulation after natural ovulation in patients with poor ovarian response.更多还原