卵泡期长方案中添加人绝经期促性腺激素对标准人群妊娠结局的影响  

Clinical effect of adding hMG to the follicular phase long protocol for standard group with normal ovarian reserve function

作　　者：梁耀允 赵淑云 黄官友 陈卓 胡竹 Liang Yaoyun;Zhao Shuyun;Huang Guanyou;Chen Zhuo;Hu Zhu(Center for Reproductive Medicine,The Affiliated Hospital of Guizhou Medical University,Guiyang 550025,China)

机构地区：[1]贵州医科大学附属医院生殖中心,贵阳550025

出　　处：《中华妇产科杂志》2021年第5期335-340,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(81460242)。

摘　　要：目的探讨在卵泡期长方案中添加人绝经期促性腺激素(hMG)对于体外受精-胚胎移植且卵巢储备功能正常的非高龄患者妊娠结局的影响。方法收集2018年1月至2020年1月在贵州医科大学附属医院生殖中心就诊的卵巢储备功能正常、非高龄患者489例,且为首次行体外受精、采用卵泡期长方案促排卵的新鲜周期,回顾性分析其临床资料。根据患者是否添加hMG及添加时机分为3组:不添加hMG组(76例)、中期添加hMG组(211例)、全程添加hMG组(202例),比较各组的基本情况、促排卵药物的效果及妊娠结局。结果中期添加hMG组和全程添加hMG组的年龄均明显高于不添加hMG组(P值分别为0.019、0.011);全程添加hMG组的基础FSH水平明显高于不添加hMG组(P<0.01)和中期添加hMG组(P=0.006),基础FSH/LH比值明显高于中期添加hMG组(P=0.009);不添加hMG组和中期添加hMG组的窦卵泡数明显高于全程添加hMG组(P值分别为0.007、0.017)。全程添加hMG组的优质胚胎率[(47±27)%]明显高于不添加hMG组(P=0.017);中期添加hMG组的胚胎种植率明显低于不添加hMG组和全程添加hMG组(P值分别为0.043及<0.01)。全程添加hMG组的临床妊娠率[76.7%(155/202)]高于不添加hMG组(P=0.039)和中期添加hMG组(P<0.01);全程添加hMG组的活产率[67.3%(136/202)]明显高于不添加hMG组(P=0.017)和中期添加hMG组(P=0.001)。结论就非高龄且卵巢储备功能正常的标准人群中卵巢储备功能相对较低者采用卵泡期长方案,在促性腺激素释放激素激动剂降调节后的促排卵过程中全程添加hMG,可通过提高胚胎的质量而改善妊娠结局。Objective To investigate the impact of adding human menopausal gonadotropin(hMG)for in vitro fertilization-embryo transfer pregnancy outcomes in a standard population of non-advanced age with normal ovarian reserve function using a long follicular phase protocol.Methods Clinical data of 489 patients with normal ovarian reserve function,who were admitted from January 2018 to January 2020 in the Affiliated Hospital of Guizhou Medical University and underwent in vitro fertilization for the first time with the long follicular phase protocol in fresh cycles,were retrospectively analyzed.The patients were divided into three groups according to whether or not to add urine-derived hMG and the timing of addition:non-addition group(group A),medium-term hMG group(group B1),whole course hMG group(group B2);the laboratory parameters of each group were observed,and the effect of ovulation induction drugs and pregnancy outcomes were compared.Results The ages of B1 and B2 groups were significantly higher than that of group A(P=0.019 and P=0.011).The basal FSH level of group B2 was significantly higher than those of group A and group B1(P<0.01 and P=0.006),and the basal FSH/LH ratio of group B2 was significantly higher than that of group B1(P=0.009).Antral follicle counts of group A and group B1 were significantly higher than that of group B2(P=0.007 and P=0.017).The superior embryo rate of group B2[(47±27)%]was significantly higher than that of group A(P=0.017).The embryo implantation rate of group B1 was significantly lower than those of group A and group B2(P=0.043 and P<0.01).The clinical pregnancy rate of group B2[76.7%(155/202)]was significantly higher than those of group A(P=0.039)and group B1(P<0.01).The live-birth rate of group B2[67.3%(136/202)]was significantly higher than those of group A(P=0.017)and group B1(P=0.001).Conclusions For non-advanced aged patients with normal ovarian reserve function,the long protocol of follicular phase is suitable for those with relatively low ovarian reserve function.Adding hMG in the

关 键 词：生殖技术 辅助 促生育素类 卵泡期 临床方案 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]