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目的:探索卵巢低反应患者自然周期的最佳取卵时机。方法:从月经周期第12日起超声监测优势卵泡大小,并测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)及孕酮(P)。非紧急取卵:优势卵泡直径≥17 mm、E2≥200 pg/ml,若LH<20 mIU/ml时,当晚11∶00注射短效促性腺激素释放激素激动剂(GnRH-a)0.1 mg或绒毛膜促性腺激素(hCG)10 000 IU诱发排卵,32~34 h后取卵。紧急取卵:诱发排卵次日复查血清LH、E2、P,若E2显著下降则安排即时取卵。监测过程中若LH≥20 mIU/ml,无论卵泡大小均安排次日早上8∶00取卵。结果:共纳入605个周期,553个周期获卵,周期取消率为8.6%(52/605)。紧急取卵345例,非紧急取卵208例。有效胚胎率在非紧急取卵组为47.6%(99/208),显著高于紧急取卵组的30.4%(105/345)。结论:紧急取卵是避免自然周期取消的有效方法,虽然相对非紧急取卵有效胚胎率较低,但仍可使部分卵巢低反应患者获得宝贵的胚胎。
Objective: To explore the optimal timing of oocyte retrieval in patients with low ovarian response. Methods: The dominant follicle size was monitored ultrasonically from the 12th day of the menstrual cycle. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone (P) were measured. Non-emergency ovulation: the dominant follicle diameter ≥ 17 mm, E2 ≥ 200 pg / ml, if LH <20 mIU / ml when 11:00 injection of short-acting gonadotropin-releasing hormone agonist (GnRH-a) Ovulation was induced by 10 000 IU of chorionic gonadotropin (hCG), and eggs were taken after 32-34 h. Emergency ovulation: the day after the test to induce ovulation serum LH, E2, P, if the E2 decreased significantly arranged immediately ovulation. Monitoring process if LH ≥ 20 mIU / ml, regardless of the size of the follicle are arranged next morning 8:00 oocyte. Results: A total of 605 cycles were enrolled, and eggs were obtained at 553 cycles. The rate of canceling cycles was 8.6% (52/605). 345 cases of emergency ovulation, 208 cases of non-emergency ovulation. The effective embryo rate was 47.6% (99/208) in non-emergency ovulation group, which was significantly higher than 30.4% (105/345) in emergency ovulation group. Conclusion: Oocyte retrieval is an effective way to avoid the natural cycle cancellation. Although the rate of effective non-emergency egg retrieval is low, some embryos with low ovarian response may still be obtained.