卵泡期长方案和拮抗剂方案,哪一个是低预后患者的更优选方案?  

Which protocol is better choice for patients with low prognosis,follicular phase GnRH agonist long protocol or GnRH antagonist protocol?

作　　者：谢重驹 劳群秀 马文敏[1] 杨美琼[1] 况沂 XIE Zhong-ju;LAO Qun-xiu;MA Wen-min;YANG Mei-qiong;KUANG Yi(Center for Reproductive Medicine of Foshan Women&Children Hospital Affiliated to Southern Medical University,Foshan 528000)

机构地区：[1]南方医科大学附属佛山市妇幼保健院生殖医学中心,佛山528000

出　　处：《生殖医学杂志》2021年第12期1581-1587,共7页Journal of Reproductive Medicine

基　　金：佛山市卫生健康局医学科研项目(20210039)。

摘　　要：目的探讨卵泡期长方案和拮抗剂方案在波塞冬(POSEIDON)1组、2组低预后人群中的促排卵效果差异。方法回顾性分析2018年1月至2020年12月在佛山市妇幼保健院生殖医学中心行IVF/ICSI助孕的600例患者共630周期的临床资料。按照促排卵方案的不同分为两组:卵泡期长方案组(303例共315周期)和拮抗剂方案组(297例共315周期),并以年龄、抗苗勒管激素(AMH)、窦卵泡计数(AFC)为变量进行倾向性得分匹配,比较两组患者的促排卵情况及妊娠结局,并进一步按获卵数及AFC分层分析两种方案患者的卵泡输出率(FORT)差异。结果两组患者的年龄、AMH、BMI、AFC以及基础激素水平等基本资料均无统计学差异(P>0.05)。促排卵结局:卵泡期长方案组患者的FORT(62.3%vs.53.5%)及卵母细胞转化指数(FOI)(51.5%vs.45.6%)均显著高于拮抗剂方案组(P<0.05),且Gn用药总量也显著升高(P<0.01),而2PN率(65.1%vs.68.8%)、可利用D3胚胎率(76.4%vs.80.1%)显著降低(P<0.05)。临床妊娠结局中,两组的临床妊娠率、胚胎种植率均无统计学差异(P>0.05)。按获卵数分层分析结果显示,当获卵数>4个时,卵泡期长方案的FORT高出5%以上;当获卵数≤4个时,两种方案的FORT相似(P>0.05)。患者按照AFC分层分析结果显示,卵泡期长方案组患者的FORT均高于拮抗剂方案组(P<0.01),且随窦卵泡数增加两组的FORT总体呈下降趋势。结论建议联合前一周期的获卵数评估卵巢反应。在获卵数>4个的POSEIDON 1组、2组患者中,卵泡期长方案有更高的FORT。当获卵数≤4个时,两个方案的FORT相似,考虑拮抗剂方案较高的成本效益,并可进行“双促排卵”策略,建议采用拮抗剂方案。Objective:To investigate the different effects of follicular phase GnRH agonist long protocol and GnRH antagonist protocol in patients with low prognosis in POSEIDON(Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number)group 1 and group 2.Methods:A retrospective cohort study was performed in Center for Reproductive Medicine of Foshan Women&Children Hospital Affiliated to Southern Medical University from January 2018 to December 2020,including 600 patients(630 cycles)undergone IVF/ICSI treatment.The patients were divided into 2 groups according to their ovarian stimulation protocol:the follicular phase GnRH agonist long protocol group(315 cycles of 303 patients)and the GnRH antagonist protocol group(315 cycles of 297 patients).Samples were adjusted by propensity score matching,which incorporated age,antimullerian hormone(AMH)and antral follicle count(AFC)into the matching procedure.Parameters during ovarian stimulation and clinical outcomes were compared between the two groups.Besides,samples were stratified by retrieved oocytes and AFC for the difference of follicular output rate(FORT).Results:There were no significant differences in baseline covariates,such as AMH,body mass index(BMI),AFC and basal hormone levels between the two groups(P>0.05).The FORT(62.3%vs.53.5%)and follicle-to-oocyte-index(FOI)(51.5%vs.45.6%)in follicular phase GnRH agonist long protocol group were significantly higher(P<0.05),and the total amount of Gn used was also significantly higher(P<0.01)than those in the GnRH antagonist protocol group.However,the 2PN rate(65.1%vs.68.8%)and the available Day 3 embryo rate(76.4%vs.80.1%)rate were significantly lower than those of GnRH antagonist protocol group(P<0.05).There were no significant differences in clinical pregnancy rate and embryo implantation rate between the two groups(P>0.05).The results of stratified analysis according to the number of retrieved oocytes showed that when the number of retrieved oocytes was more than 4,the FORT of in follicular phase GnRH agonist long pr

关 键 词：卵泡期长方案 波塞冬 卵泡输出率 低预后 

分 类 号：R711.6[医药卫生—妇产科学]