【摘要】 目的 比较卵泡期高孕激素状态下促排卵（PPOS）方案和卵泡期长方案在子宫内膜异位症（EMs）患者行体外受精/卵胞浆内单精子注射（IVF/ICSI）助孕治疗中的临床妊娠结局。方法 选择2018年1月至2024年1月期间因EMs合并不孕症在我院生殖医学中心行IVF/ICSI助孕的患者（282个取卵周期）为研究对象，根据促排卵方案的不同分为卵泡期长方案组（n=131）和PPOS方案组（n=151），比较两组患者的促排卵情况、临床结局及累积妊娠情况。结果 两组患者的基本情况均无显著性差异（P>0.05）。与PPOS方案组相比，卵泡期长方案组促性腺激素（Gn）启动剂量低[（200.90±115.07）U vs.(258.28±65.30)U]、Gn用量大[（3 292.37±1 376.43）U vs.(2 935.60±962.30)U]、Gn用时长[（13.05±2.96）d vs.(10.82±2.30)d]、获卵数多[（12.67±7.41）vs.(9.74±6.83)]，且差异均具有统计学意义（P<0.05）。卵泡期长方案组的优胚数及可利用胚胎数均高于PPOS方案组，而优胚率低于PPOS方案组，但差异尚无统计学意义（P>0.05）。临床结局比较中，卵泡期长方案组的临床妊娠率（49.59%vs.61.41%）显著低于PPOS方案组（P<0.05），流产率、活产率、早产率也均低于PPOS方案组，但差异尚无统计学意义（P>0.05）。两组间的累积临床妊娠率、获得第一次临床妊娠所需时间、累积活产率及获得第一次活产所需时间均无显著性差异（P>0.05）。结论 EMs不孕患者行IVF/ICSI助孕时，与卵泡期长方案相比，PPOS方案具有Gn用量少、Gn用时短、优胚率高、临床妊娠率高的优势，可作为EMs不孕患者促排卵的优选方案。更多还原

【Abstract】 Objective:To compare the clinical pregnancy outcomes between progestin-primed ovarian stimulation(PPOS)and follicular phase long protocol in IVF/ICSI treatment for patients with endometriosis.Methods:The infertile patients with endometriosis treated by IVF/ICSI(282oocyte retrieval cycles)in the Reproductive Medicine Center of Jiangmen Central Hospital between January 2018and January 2024were included in this retrospective study.According to the ovulation stimulation strategies,the patients were divided into two groups:follicular phase long protocol group(n=131)and PPOS group(n=151).The status of ovulation stimulation,clinical outcomes and cumulative pregnancy outcomes were compared between the two groups.Results:The basic characteristics were comparable in both groups(P>0.05).Compared with the PPOS group,the follicular phase long protocol group has lower gonadotropin(Gn)starting dose[(200.90±115.07)U vs.(258.28±65.30)U],higher total Gn dose[(3 292.37±1 376.43)U vs.(2 935.60±962.30)U],longer duration of Gn usage[(13.05±2.96)d vs.(10.82±2.30)d]and more oocytes retrieved[(12.67±7.41)vs.(9.74±6.83)],showing statistically significant differences(P<0.05).The number of high-quality embryos and available embryos in the follicular phase long protocol group were higher than those in the PPOS group,while the rate of high-quality embryos was lower than that in the PPOS group,showing no statistically significant differences(P>0.05).As for the clinical outcomes,the clinical pregnancy rate in the follicular phase long protocol group was significantly lower than that of the PPOS group(49.59% vs.61.41%,P<0.05).The abortion rate,live-birth rate and the premature birth rate in the follicular phase long protocol group were also lower than those of the PPOS group,showing no statistically significant differences(P>0.05).There were no significant differences in the cumulative clinical pregnancy rate,the duration between the first treatment and the first clinical pregnancy,the cumulative live birth rate and the duration between the first treatment and the first live birth between the two groups(P>0.05).Conclusions:Compared with the follicular phase long protocol,PPOS is superior in lower dosage and shorter duration of Gn use,higher rate of high-quality embryos and clinical pregnancy rate so as to be an optimal option for infertile patients with endometriosis.更多还原