早卵泡期长效长方案和拮抗剂方案在预期卵巢高反应患者中的应用比较及自身对照研究  

Comparison of early follicular phase prolonged protocol and gonadotropin-releasing hormone antagonist protocol in patients with expected high ovarian response:a retrospective cohort study and self-controlled study

作　　者：李真[1] 张俊韦 刘慧[1] 管一春[1] 李嘉恒[1] 王兴玲[1] Li Zhen;Zhang Junwei;Liu Hui;Guan Yichun;Li Jiaheng;Wang Xingling(Reproductive Center of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第三附属医院生殖中心,450052

出　　处：《中华生殖与避孕杂志》2020年第12期978-985,共8页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨早卵泡期长效长方案(长长方案)和拮抗剂方案在预期卵巢高反应患者中的临床应用。方法回顾性队列研究分析2015年9月至2019年5月期间在郑州大学第三附属医院生殖中心行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的预期卵巢高反应患者共2575个周期的临床资料,其中长长方案组1855个周期,拮抗剂方案组720个周期,比较两组患者的临床和实验室指标、全部胚胎冷冻第一周期移植的妊娠结局、每取卵周期的累积妊娠率及首次IVF/ICSI助孕周期妊娠所需时间(TTP);并采用自身对照研究回顾性分析其中前次行长长方案助孕再次拮抗剂方案助孕周期的临床资料及前次行长长方案助孕再次行长长方案助孕周期的临床资料。结果①两组患者的年龄、体质量指数(BMI)、基础卵泡刺激素(bFSH)、抗苗勒管激素(AMH)、人绒毛膜促性腺激素(hCG)注射日内膜厚度差异均无统计学意义(P>0.05)。长长方案组促性腺激素(Gn)启动量[(135.11±36.61)IU]、获卵数[(17.79±7.80)枚]、可利用胚胎数[(9.08±5.56)枚]、优质胚胎数[(5.18±4.56)枚]明显低于拮抗剂组[(170.12±53.94)IU、(20.60±9.92)枚、(10.96±6.59)枚、(6.47±4.97)枚](P<0.001、P<0.001、P<0.001、P=0.012);而Gn使用时间[(14.3±3.23)d]、Gn使用总量[(2322.08±1020.48)IU]、中重度卵巢过度刺激综合征(OHSS)发生率(9.54%)、hCG扳机后中重度OHSS发生率(9.54%)、新鲜周期临床妊娠率(69.44%)明显高于拮抗剂组[(9.97±2.47)d、(1884.19±774.16)IU、0.83%、3.95%、53.94%,P均<0.001]。②全部胚胎冷冻第一周期移植的临床妊娠率和流产率两组比较差异无统计学意义(P>0.05)。③两组患者累积妊娠率比较差异无统计学意义(P>0.05);拮抗剂组新鲜周期移植后妊娠和冷冻胚胎周期移植后妊娠的周期TTP[(47.67±3.18)d、(140.33±45.43)d]要明显少于长长方案组[(81.25±3.72)d、(185.19±46.52)d,P均<0.001],但总移植周期TTP�Objective To investigate clinical outcomes and safety of the early follicular phase prolonged protocol and gonadotropin-releasing hormone antagonist(GnRH-A)protocol of patients with expected high ovarian response.Methods A retrospective cohort analysis of the expected high ovarian response patients during in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)was performed in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from September 2015 to May 2019,including 1855 gonadotropin-releasing hormone agonist(GnRH-a)cycles and 720 GnRH-A cycles.The main outcome measures were the clinical outcomes,the incidence of moderate to severe ovarian hyperstimulation syndrome(OHSS),the pregnancy outcome of the first cycle of whole embryo freezing,cumulative pregnancy rate per oocytes retrieval cycle and time to pregnancy(TTP).And a self-controlled study was performed to compare the clinical outcomes of the patients who underwent early follicular phase prolonged protocol previously and underwent GnRH-A protocol or early follicular phase prolonged protocol later.Results 1)There was no statistical difference between GnRH-a group and GnRH-A group in maternal age,body mass index(BMI),basal follicle-stimulating hormone(bFSH),anti-Müllerian hormone(AMH)and intima thickness on the human chorionic gonadotropin(hCG)trigger day(P>0.05).Compared with the Gn start-up[(170.12±53.94)IU],No.of obtained oocytes(20.60±9.92),No.of available embryos(10.96±6.59),and No.of high-quality embryos(6.47±4.97)in the GnRH-A group,the gonadotropins(Gn)start-up[(135.11±36.61)IU],No.of obtained oocytes(17.79±7.80),No.of available embryos(9.08±5.56),and No.of high-quality embryos(5.18±4.56)in the early follicular phase prolonged protocol group were significantly reduced correspondingly(P<0.001,P<0.001,P<0.001,P=0.012),while Gn used duration[(14.3±3.23)d],total Gn used dosage[(2322.08±1020.48)IU],incidence of moderate to severe OHSS after hCG trigger(9.54%)and fresh cycle clinical pregna

关 键 词：早卵泡期长效长方案 拮抗剂方案 临床妊娠 卵巢过度刺激综合征 累积妊娠率 妊娠所需时间 

分 类 号：R714.8[医药卫生—妇产科学]