Abstract: Objective　To compare the effects of luteal phase ovarian stimulation (LPOS) and gonadotropin-releasing hormone (GnRH) antagonist schemes on in vitro fertilization (IVF) embryo transfer for patients with diminished ovarian reserve (DOR). Methods　A total of 273 cycles of IVF conducted from May 2014 to July 2021 Binzhou Medical University Hospital were retrospectively analyzed. According to the ovulation induction schemes, the cycles were divided into a GnRH antagonist group (138 cycles) and an LPOS group (135 cycles). The ovulation induction outcomes, laboratory indicators, and clinical pregnancy outcomes were compared between these two groups. The measurement data of normal distribution were expressed as (x±s), and were compared between these two groups by independent-sample t test and between ≥3 groups by one-way ANOVA. The enumeration data were expressed as rate (%), and compared by χ² test or Fisher's exact test. Results　There were no statisitcal differences in age, body mass index (BMI), anti-mullerian hormone (AMH), antral follicle count (AFC), infertility years, basal follicle stimulating hormone (FSH), basal luteinizing hormone (LH), time taking gonadotropins (Gn), and Gn dosage between these two groups (t=-1.921, 1.018, 1.902, 1.846, -0.775, -0.064, 1.552, 1.149, and 0.896; all P>0.05). The levels of LH and estradiol (E2) on the trigger day and the number of obtained oocytes in the LPOS group were lower than those in the GnRH antagonist group [(3.74±3.20) IU/L vs. (6.44±6.18) IU/L, (2 561.03±2 120.72) pmol/L vs. (3 842.46±3 563.95) pmol/L, and (3.20±1.95) vs. (4.21±2.66)], with statistical differences (t=4.306, 3.432, and 3.345; all P<0.05). The available embryo rate and the high-quality embryo rate in the LPOS group were higher than those in the GnRH antagonist group (χ²=4.023 and 8.874; both P<0.05). Conclusion　LPOS can achieve an ideal high-quality embryo rate and a clinical pregnancy rate in women with diminished ovarian reserve.

Key words: Luteal phase ovarian stimulation scheme, GnRH antagonist scheme, Diminished ovarian reserve, In vitro fertilization embryo transfer

摘要： 目的　比较黄体期促排卵方案和拮抗剂方案在卵巢储备功能下降患者体外受精胚胎移植中的应用效果。方法　回顾性分析2014年5月至2021年7月在滨州医学院附属医院行体外受精（in vitro fertilization，IVF）治疗的273个周期，根据所用促排卵方案的不同，分为拮抗剂组（138个周期）和黄体期促排卵组（135个周期），比较两组促排卵结局、实验室相关指标及临床妊娠结局。符合正态分布的计量资料用（x±s）表示，两组间比较采用两独立样本t检验，多组间比较采用单因素方差分析。计数资料用率（%）表示，组间比较采用χ²检验或Fisher精确性检验。结果　两组的年龄、体质指数（BMI）、抗缪勒氏管激素（AMH）、基础窦卵泡计数（AFC）、不孕年限、基础卵泡刺激素（FSH）、基础黄体生成素（LH）、促性腺激素（Gn）天数、Gn用量比较差异均无统计学意义（t=-1.921、1.018、1.902、1.846、-0.775、-0.064、1.552、1.149、0.896，均P>0.05）；与拮抗剂组相比，黄体期促排卵组扳机日LH［（3.74±3.20）IU/L比（6.44±6.18）IU/L］、扳机日雌二醇（E2）［（2 561.03±2 120.72）pmol/L比（3 842.46±3 563.95）pmol/L）］、获卵数更低［（3.20±1.95）枚比（4.21±2.66）枚］，差异均有统计学意义（t=4.306、3.432、3.345，均P<0.05），而可利用胚胎率、优质胚胎率更高（χ²=4.023、8.874，均P<0.05）。结论　黄体期促排卵方案在卵巢储备功能下降患者中也可获得较理想的优质胚胎率及临床妊娠率。

关键词: 黄体期促排卵方案, 拮抗剂方案, 卵巢储备功能下降, 体外受精胚胎移植