体外受精长方案晚卵泡期不同浓度孕酮干预对妊娠结局的影响  

Influence of the different concentration of progesterone intervention on pregnancy outcomes in late follicular phase of gonadotropin-releasing hormone agonist cycles of in vitro fertilization

作　　者：孙金莉[1] 颜晓红[1] 林莉[1] 高红 陈曦[1,2] Sun Jinli;Yan Xiaohong;Lin Li;Gao Hong;Chen Xi(Reproductive Medical Center of the First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Department of Neurosurgery of the First Affiliated Hospital of Xiamen University)

机构地区：[1]厦门大学附属第一医院生殖中心,361003 [2]厦门大学附属第一医院神经外科

出　　处：《中华生殖与避孕杂志》2019年第10期803-809,共7页Chinese Journal of Reproduction and Contraception

基　　金：福建省卫生计生青年科研课题项目(2017-2-100);福建省自然科学基金计划项目(2018J01376,2019J01574);福建省卫生健康青年科研课题项目(2019-2-48)。

摘　　要：目的探讨体外受精(IVF)长方案在晚卵泡期不同浓度血清孕酮干预后对新鲜胚胎移植妊娠结局的影响。方法回顾性分析2015年6月至2017年12月期间在厦门大学附属第一医院生殖中心就诊行体外受精-胚胎移植(IVF-ET)治疗中,分别行长方案[促性腺激素释放激素激动剂(GnRH-a)组,352例]和拮抗剂方案[促性腺激素释放激素拮抗剂(GnRH-A)组,277例]患者的临床资料,根据人绒毛膜促性腺激素(hCG)注射日血清孕酮水平将患者分为4个亚组,A组:孕酮水平<1.2μg/L;B组:1.2μg/L≤孕酮水平<1.5μg/L;C组:1.5μg/L≤孕酮水平<1.75μg/L;D组:孕酮水平≥1.75μg/L,对比各亚组患者分别行新鲜周期卵裂胚(第3日)移植和囊胚(第5日)移植后临床妊娠率、流产率等各项指标。结果在长方案中,A、B、C、D组患者的临床妊娠率分别为55.00%(110/200)、54.17%(39/72)、52.00%(26/50)和30.00%(9/30),而拮抗剂组则分别为50.71%(71/140)、48.61%(35/72)、35.00%(14/40)和20.00%(5/25),无论哪种促排卵方案中,D组患者临床妊娠率均低于其他各亚组,且差异具有统计学意义(P<0.05)。而拮抗剂方案中,C组患者临床妊娠率也已经明显下降(P<0.05)。对比各亚组分别实行卵裂胚和囊胚移植,拮抗剂方案中处于D组行卵裂胚移植者,临床妊娠率仅为16.67%,明显低于其他各亚组。而长方案中C组行卵裂胚移植者临床妊娠率(44.00%)低于A和B组患者(50.00%,50.00%),且差异具有统计学意义(P<0.05)。结论长方案中晚卵泡期孕酮水平在>1.75μg/L时明显降低妊娠结局,其中行卵裂胚移植组在孕酮水平上升至1.5μg/L时明显降低临床妊娠率。拮抗剂方案中晚卵泡期孕酮水平高于1.5μg/L,明显对临床结局有不利影响。Objective To evaluate the clinical pregnancy outcomes of in vitro fertilization(IVF)cycles undergoing gonadotropin-releasing hormone agonist(GnRH-a)or gonadotropin-releasing hormone antagonist(GnRH-A)protocols in different progesterone concentration intervention in late follicular phase.Methods In this retrospective study,the data of 352 IVF GnRH-a and 277 IVF GnRH-A cycles were performed in Reproductive Medical Center of the First Affiliated Hospital of Xiamen University from June 2015 to December 2017.According to the different concentration of progesterone intervention on human chorionic gonadotropin(hCG)injection day,patients were divided into four subgroups(group A,progesterone<1.2μg/L;group B:1.2μg/L≤progesterone<1.5μg/L;group C:1.5μg/L≤progesterone<1.75μg/L;group D:progesterone≥1.75μg/L.The clinical pregnancy rate and the abortion rate were compared among the above groups in which patients received day 3 or day 5 embryos transplanted.Results The clinical pregnancy rates of the four groups(A-D)undergoing GnRH-a protocol were 55.00%(110/200),54.17%(39/72),52.00%(26/50),and 30.00%(9/30),and those undergoing GnRH-A protocol were 50.71%(71/140),48.61%(35/72),35.00%(14/40),and 20.00%(5/25),respectively.The clinical pregnancy rates of both group D undergoing different protocols were significantly lower than other progesterone intervention groups(P<0.05).The clinical pregnancy rates undergoing GnRH-A protocol were significantly decreased in group C(P<0.05).The lowest clinical pregnancy rate was 16.67%in group D undergoing GnRH-A protocol with day 3 embryo transplanted,significantly lower than other subgroups.The clinical pregnancy rates undergoing GnRH-a protocol with day 3 embryo transplanted were significantly decreased when progesterone concentration elevated to the level of group C(group C vs.groups A,B:44.00%vs.50.00%,50.00%).Conclusion The clinical pregnancy outcomes were significantly decreased when the late follicular progesterone intervention elevated to 1.75μg/L in those patients undergoing

关 键 词：受精 体外 胚胎移植 孕酮早升 控制性促排卵 干预 

分 类 号：R714.8[医药卫生—妇产科学]