体外受精-胚胎移植拮抗剂方案前行口服避孕药预处理在非多囊卵巢综合征患者中的疗效评价  

The clinical effects of oral contraceptive pretreatment on the outcome of gonadotropin releasing hormone antagonist protocol in non-polycystic ovary syndrome patients

作　　者：席思思[1] 单学敏[1] 王宁[1] 曾诚[1] 李昕[1] 薛晴[1] 徐阳[1] 尚鶄[1] 杨秀丽[1] Xi Sisi;Shan Xuemin;Wang Ning;Zeng Cheng;Li Xin;Xue Qing;Xu Yang;Shang Jing;Yang Xiuli(Reproductive Medical Center of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院妇产科,北京100034

出　　处：《中华医学杂志》2021年第28期2228-2232,共5页National Medical Journal of China

基　　金：国家自然科学基金(91949113)。

摘　　要：目的探讨非多囊卵巢综合征患者接受拮抗剂方案体外受精-胚胎移植(IVF-ET)治疗前应用口服避孕药(OC)预处理的临床效果。方法采用回顾性队列研究,分析2017年1月至2019年5月期间在北京大学第一医院生殖中心接受IVF-ET/单精子卵胞浆内注射(ICSI)治疗的拮抗剂方案的患者436例,分为OC预处理组(144例,147个取卵周期)和未预处理组(292例,306个取卵周期),比较两组的治疗经过及妊娠结局,主要结局指标为取卵周期累积妊娠率,次要结局指标为获卵数、MⅡ卵子数、胚胎数及鲜胚移植周期临床妊娠率。结果OC预处理组和未处理组年龄M(Q_(1),Q_(3))分别为33(30,36)和34(30,38)岁。OC预处理组MⅡ卵子(7/9)高于未预处理组(6/8)(P=0.002),两组的取卵周期累积妊娠率(OC预处理组61.7%比未预处理组54.6%)、鲜胚移植周期移植临床妊娠率(34.4%比35.6%)、获卵数(9个比8个)及胚胎数(6个比6个)差异均无统计学意义。结论非多囊卵巢综合征患者在拮抗剂方案前行OC预处理可增加成熟卵母细胞数,对累积妊娠率有增加趋势。Objective To evaluate the clinical effect of oral contraceptive(OC)pretreatment on the outcome of gonadotropin releasing hormone antagonist(GnRH-a)protocol in patients with non-polycystic ovary syndrome.Methods From January 2017 to May 2019,a total of 436 patients undergoing in vitro fertilization and embryo transfer/Intracytoplasmic sperm injection(IVF-ET/ICSI)treatment in Peking University First Hospital reproductive center clinic were included in this retrospective cohort study.A total of 144 patients(147 cycles)used OC pretreatment prior to GnRH-a protocol and 292 patients(306 cycles)used GnRH-a protocol without OC pretreatment.The drug usage as well as pregnant outcomes between groups were examined.The primary outcome was the cumulative clinical pregnancy rate of oocyte retrieval cycle and the secondary outcome included the number of oocytes,MⅡoocytes,embryos and clinical pregnancy rate of fresh embryo transfer cycle.Results The median ages(and Q_(1),Q_(3))of OC pretreatment group and non-OC group were 33(30,36)and 34(30,38)years old,respectively.The number of MⅡoocytes was higher in OC pretreatment group(7/9)than in non-OC group(6/8)(P=0.002).The significant difference were not found in the cumulative clinical pregnancy rate of each oocyte retrieval cycle(61.7%vs 54.6%),the clinical pregnancy rate of fresh embryo transfer cycle(34.4%vs 35.6%),and the number of oocytes(9 vs 8)and embryos(6 vs 6)between groups.Conclusion Our findings suggest that compared to non-OC pretreatment group,pretreatment with OC is associated with more MⅡoocytes,and with an increasing trend of the cumulative clinical pregnancy rate in non-polycystic ovary syndrome patients undergoing fresh IVF-ET/ICSI.

关 键 词：避孕药 口服 拮抗剂 预处理 体外受精-胚胎移植 单精子卵胞浆内注射 

分 类 号：R714.8[医药卫生—妇产科学]