不同卵巢刺激方案下年龄因素对卵巢低反应人群新鲜周期活产率的影响  

Influence of female age on the fresh cycle live birth rate of different controlled ovarian hyperstimulation protocols in poor ovarian response patients

作　　者：李飞[1] 叶田[1] 孔慧娟[1] 李婧[1] 胡琳莉[1] 杨洪毅[1] 郭艺红[1] 李刚[1] Li Fei;Ye Tian;Kong Huijuan;Li Jing;Hu Linli;Yang Hongyi;Guo Yihong;Li Gang(Center for Reproductive Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院生殖医学中心,450052

出　　处：《中华妇产科杂志》2021年第7期482-488,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(81771534);河南省科技攻关计划(172102310082);河南省医学科技攻关联合项目(LHGJ20200933);中华医学会生殖医学青年医师研究与发展项目(18010240753)。

摘　　要：目的探讨不同卵巢刺激方案下年龄因素对卵巢低反应人群新鲜周期活产率的影响。方法回顾性分析郑州大学第一附属医院于2014年2月至2018年11月接受辅助生殖治疗的3342例卵巢低反应患者的临床资料,根据不同卵巢刺激方案分为卵泡期长效长方案组(1375例)、黄体期短效长方案组(1161例)、拮抗剂方案组(806例),每组再根据年龄分为4个年龄段:≤30岁、31~35岁、36~40岁、>40岁,并比较分析各年龄段患者的新鲜周期活产率。结果卵泡期长效长方案组中,年龄≤30岁、31~35岁、36~40岁、>40岁患者的新鲜周期活产率分别为39.4%(228/579)、36.1%(135/374)、16.6%(48/290)、3.0%(4/132);黄体期短效长方案组中,各年龄段患者的新鲜周期活产率分别为32.1%(99/308)、20.8%(55/264)、13.0%(45/346)、7.0%(17/243);拮抗剂方案组中,各年龄段患者的新鲜周期活产率分别为22.8%(26/114)、16.3%(25/153)、11.2%(31/278)、3.8%(10/261);各组新鲜周期活产率均随年龄增大而明显降低(P均<0.01)。当年龄≤35岁时,卵泡期长效长方案组的新鲜周期活产率明显优于其他两组(P均<0.01);>35岁时,3种方案新鲜周期活产率无明显差异(P均>0.05)。3种方案下年龄与活产率的多因素logistic回归分析显示,年龄是活产率的独立影响因素(卵泡期长效长方案组:OR=0.898,95%CI为0.873~0.916,P<0.01;黄体期短效长方案组:OR=0.926,95%CI为0.890~0.996,P<0.01;拮抗剂方案组:OR=0.901,95%CI为0.863~0.960,P<0.01)。结论年龄是卵巢低反应患者活产率的独立影响因素,无论采取何种卵巢刺激方案,卵巢低反应患者的新鲜周期活产率均随女性年龄的增长而降低。卵泡期长效长方案在年龄≤35岁患者中有更高的新鲜周期活产率,这值得进一步探讨。Objective To investigate the influence of age on the fresh cycle live birth rate in patients with poor ovarian response in different controlled ovarian hyperstimulation groups.Methods The clinical data of 3342 patients in The First Affiliated Hospital of Zhengzhou University from February 2014 to November 2018 were retrospectively collected,including early-follicular phase long-acting gonadotropin-releasing hormone(GnRH)agonist long protocol group(1375 cases),mid-luteal phase short-acting GnRH agonist long protocol group(1161 cases)and GnRH antagonist protocol group(806 cases);each group was divided into 4 subgroups according to age:≤30 years,31-35 years,36-40 years and>40 years,the pregnancy outcomes in each age subgroup were analyzed under different controlled ovarian hyperstimulation protocols.Results In early-follicular phase long-acting GnRH agonist long protocol group,the final live birth rates of each age subgroup were 39.4%(228/579),36.1%(135/374),16.6%(48/290)and 3.0%(4/132);in mid-luteal phase short-acting GnRH agonist long protocol group,live birth rates of each age subgroup were 32.1%(99/308),20.8%(55/264),13.0%(45/346)and 7.0%(17/243);in GnRH antagonist protocol group,live birth rates of each age subgroup were 22.8%(26/114),16.3%(25/153),11.2%(31/278),and 3.8%(10/261);the live birth rate of each group decreased significantly with the increase of age(all P<0.01).When the age≤35 years old,the fresh cycle live birth rate of the early-follicular phase long-acting GnRH agonist long protocol group was significantly better than those of the other two groups(all P<0.01).The multivariate logistic regression analysis of age and live birth rate of the three controlled ovarian hyperstimulation groups showed age was the independent influence factor(OR=0.898,95%CI:0.873-0.916,P<0.01;OR=0.926,95%CI:0.890-0.996,P<0.01;OR=0.901,95%CI:0.863-0.960,P<0.01).Conclusions Age is an independent influencing factor for the prediction of fresh cycle live birth rate in low ovarian response patients.No matter which controlled

关 键 词：不育 女(雌)性 年龄因素 排卵诱导 妊娠率 临床方案 卵巢低反应 活产率 

分 类 号：R714.8[医药卫生—妇产科学]