以鲜胚移植周期活产率和每取卵周期累积活产率评估早卵泡期长效长方案与黄体中期短效长方案的临床效果  

Evaluating the clinical effects of long-acting long protocol in early follicular phase and short-acting long protocol in middle luteal phase by live birth rate per transplant cycle and cumulative live birth rate per oocytes retrieval cycle

作　　者：尹轶莎 李秋圆 张翠莲[1] 张少娣[1] Yin Yisha;Li Qiuyuan;Zhang Cuilian(Henan Provincial People's Hospital (People's Hospital of Henan University),Reproductive Medicine Center,Zhengzhou 450003)

机构地区：[1]河南省人民医院(河南大学人民医院)生殖医学中心,郑州450003

出　　处：《现代妇产科进展》2020年第11期809-814,共6页Progress in Obstetrics and Gynecology

摘　　要：目的:比较早卵泡期长效长方案与黄体中期短效长方案的鲜胚移植周期活产率和每取卵周期累积活产率,探讨两种垂体降调节方案的优劣势。方法:回顾分析2016年3月至2018年12月首次在河南省人民医院生殖中心行垂体降调节方案控制性促排卵的7665个周期,根据方案分为早卵泡期长效长方案组(A组,4854例)和黄体中期短效长方案(B组,2811例)。比较两组患者的一般情况及临床结局,通过多因素Logistic回归分析调整混杂因素后分析两种促排卵方案对临床结局的影响。结果:两种促排卵方案的年龄、不孕年限、基础FSH等一般情况比较,差异均无统计学意义(P>0.05)。黄体中期短效长方案组的HCG日E2、HCG日LH均明显高于早卵泡期长效长方案(P<0.05);黄体中期短效长方案组的Gn总量、Gn总天数、HCG日子宫内膜厚度、HCG日优势卵泡数均明显低于早卵泡期长效长方案组(P<0.05);黄体中期短效长方案组的获卵总数、成熟卵子数、正常受精数、D3可利用胚胎数及因OHSS周期取消率均明显低于早卵泡期长效长方案组(P<0.05);黄体中期短效长方案组的新鲜移植周期临床妊娠率、活产率及累积活产率均低于早卵泡期长效长方案组(P<0.05);调整混杂因素后,黄体中期短效长方案组的新鲜移植周期活产率(OR=0.72,95%CI为0.61~0.84)及每取卵周期累积活产率(OR=0.76,95%CI为0.65~0.90)仍明显低于早卵泡期长效长方案组。分层分析调整混杂因素后显示获卵1~9枚患者中,黄体中期短效长方案组新鲜移植周期活产率(OR=0.68,95%CI为0.56~0.82)和每取卵周期累积活产率(OR=0.68,95%CI为0.56~0.83)均明显低于早卵泡期长效长方案组(P<0.05);在获卵数≥10枚患者人群中两种促排卵方案的临床结局均无差异。结论:早卵泡期长效长方案较黄体期短效长方案可改善患者新鲜周期妊娠结局,在获卵数1~9枚患者中可以获得更高的鲜胚移植周期活产率Objective:To compare live birth rate per transplant cycle and cumulative live birth rate per oocytes retrieval cycle of long-acting long protocol in early follicular phase and short-acting long protocol in the middle luteal phase to explore the advantages and disadvantages of the two kinds of pituitary down-regulation protocol.Methods:7665 controlled ovarian stimulation cycles with pituitary down-regulation protocol for the first time from Mar.2016 to Dec.2018 in the Reproductive Medicine Center of Henan Provincial People's Hospital were studied retrospectively,which were divided into group A(long-acting long protocol in early follicular phase,4854 cases)and group B(short-acting long protocol in the middle luteal phase,2811 cases)according to the controlled ovarian stimulation protocol.The general conditions,clinical and laboratory indicators of the two groups were compared,and multivariate Logistic regression analysis after adjusting confounding factors was used to investigate the effect of the two controlled ovarian stimulation protocol on clinical outcomes.Results:There were no significant differences in general conditions of the two controlled ovarian stimulation protocol,such as age,infertility years,basic FSH and so on(P>0.05).The E2 and LH On HCG injection day in group B were significantly higher than those in group A(P<0.05).Dosage of Gn used and duration of Gn used,endometrial thickness on HCG injection day and number of dominant follicles on HCG injection day in group B were significantly lower than those in group A(P<0.05).Number of oocytes retrieved,number of mature oocytes,number of normal fertilized eggs,D3 number of useable embryos and Cycle cancellation rate because of OHSS in group B were significantly lower than those in group A(P<0.05).The clinical pregnancy rate,live birth rate in fresh transplant cycle and cumulative live birth rate in group B were lower than those in group A(P<0.05).After adjusting for confounding factors,the live birth rate in fresh transplant cycle(OR=0.72,95%CI:0.61~0.84)

关 键 词：早卵泡期长效长方案 黄体中期短效长方案 IVF-ET 累积活产率 

分 类 号：R71[医药卫生—妇产科学]