早卵泡期长方案中半剂量和全剂量GnRH-a降调方案对IVF/ICSI妊娠结局的影响  

Comparison of IVF/ICSI outcomes between half-dose and full-dose GnRH agonist downregulation in long protocol during early-follicular phase

作　　者：王龙达 陈孟祥 速存梅[1] 严高凤 杨文娟[1] 姚有林 刘江[1] 鲁玲 赵树华[1] WANG Long-da;CHEN Meng-xiang;SU Cun-mei;YAN Gao-feng;YANG Wen-juan;YAO You-lin;LIU Jiang;LU Ling;ZHAO Shu-hua(First Affiliated Hospital of Kunming Medical University,Kunming 650032)

机构地区：[1]昆明医科大学第一附属医院,昆明650032

出　　处：《生殖医学杂志》2021年第11期1414-1420,共7页Journal of Reproductive Medicine

基　　金：国家自然科学基金项目(81760269);云南省应用基础研究面上项目(2018FB126);云南省中青年学术和技术带头人后备人才项目(2017HB046);云南省医学学科带头人项目(D-2017021);云南省科技厅昆明医科大学应用基础研究联合专项资金(2017FE468)。

摘　　要：目的比较早卵泡期长方案中半剂量和全剂量促性腺激素释放激素激动剂(GnRH-a)降调对不孕症患者新鲜胚胎移植和冻融胚胎移植(FET)妊娠结局的影响。方法回顾性分析2019年1月至2020年6月在我院行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗不孕症患者的临床资料,共405个周期。根据早卵泡期长方案中GnRH-a使用剂量的不同分为半剂量组(早卵泡期长方案中使用1.87 mg的GnRH-a,共136个周期)和全剂量组(使用3.75 mg的GnRH-a,共269个周期),比较两组患者的一般资料、促排卵情况、实验室指标、胚胎移植情况和临床结局。同时,根据不孕因素不同分为多囊卵巢综合征(PCOS)组和非PCOS组,比较两组患者新鲜移植周期和FET周期的临床妊娠率;根据不同的FET日与控制性卵巢刺激(COS)降调日时间间隔将FET患者分为两个亚组:间隔≤15周组和>15周组,比较各亚组间FET的临床妊娠率。结果半剂量组和全剂量组患者一般资料比较均无显著性差异(P>0.05);半剂量组启动日和扳机日血清LH水平显著高于全剂量组(P<0.05);两组间其他激素水平、子宫内膜厚度、Gn天数和Gn总量比较均无显著性差异(P>0.05);两组间受精率、优胚率和囊胚形成率比较均无显著性差异(P>0.05)。对于新鲜胚胎移植患者,半剂量组和全剂量组的临床妊娠率、胚胎着床率和流产率比较均无显著性差异(P>0.05);对于FET患者,半剂量组的移植胚胎数、子宫内膜厚度和临床妊娠率均显著低于全剂量组(P<0.05)。对于PCOS患者,半剂量组新鲜移植周期临床妊娠率与全剂量组比较无显著性差异(P>0.05),FET周期临床妊娠率略低于全剂量组,但差异尚无统计学意义(P>0.05);对于非PCOS患者,半剂量组新鲜移植周期临床妊娠率与全剂量组比较无显著性差异(P>0.05),FET周期临床妊娠率显著低于全剂量组(P<0.05)。在FET日与COS降调日间隔≤15周的患者中,半剂量Objective:To compare the fresh or frozen-thawed embryo transfer(FET)outcomes of administration of half-dose or full-dose of GnRH agonist(GnRH-a)in long protocol of early-follicular phase.Methods:The clinical data of 405 IVF/ICSI cycles in our center from January 2019 to June 2020 were retrospectively analyzed.The cycles were divided into two groups according to the dosage of GnRH-a:half-dose group(1.87 mg,n=136)and full-dose group(3.75 mg,n=269).The general data,ovulation induction,laboratory indexes,embryo transfer and clinical outcomes of the two groups were compared.Then the cycles were divided into polycystic ovary syndrome(PCOS)group and non-PCOS group according to the different infertility factors.The clinical pregnancy rates of fresh transfer cycle and FET cycle were compared between the two groups.According to different intervals between FET day and controlled ovarian stimulation(COS)down-regulation day,the FET cycles were divided into two subgroups:the interval≤15 weeks group and the interval>15 weeks group.The clinical pregnancy rate of FET was compared among the subgroups.Results:The basic characteristics did not show any significant differences between half-dose group and full-dose group(P>0.05).The serum LH levels on the initial day of COS and HCG trigger day in half-dose group were significantly higher than those in full-dose group(P<0.05).There were no significant differences in the other hormone levels,endometrial thickness,Gn days and total Gn doses used,fertilization rate,excellent embryo rate and blastocyst formation rate between the two groups(P>0.05).For the fresh cycles,there were no significant differences in clinical pregnancy rate,embryo implantation rate and abortion rate between half-dose group and full-dose group(P>0.05).For the FET cycles,the number of embryos transferred,endometrial thickness and clinical pregnancy rate in the half-dose group were significantly lower than those in the full-dose group(P<0.05).For PCOS patients,there was no significant difference in clinical pregnanc

关 键 词：促性腺激素释放激素激动剂 早卵泡期长方案 体外受精 控制性卵巢刺激 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]