IVF-ET中采用不同促排卵及促性腺激素用药方案的波塞冬标准组4POR患者促排卵情况及妊娠结局  

Ovulation induction and pregnancy outcomes of POR patients with POSEIDON group 4 treated with EFLL,MLSL,and GnRH-ant and different gonadotrophins regimens in IVF-ET

作　　者：祁玉娟[1,2] 曹义娟[1,2] 孙擎擎[1,2] 顾娟 严晓南[1,2] QI Yujuan;CAO Yijuan;SUN Qingqing;GU Juan;YAN Xiaonan(Clinical Center of Reproductive Medicine,Xuzhou Central Hospital,Xuzhou 221000,China;不详)

机构地区：[1]徐州市中心医院生殖中心,江苏徐州221000 [2]东南大学生殖医学遗传研究所

出　　处：《山东医药》2022年第17期22-27,共6页Shandong Medical Journal

基　　金：国家自然科学基金项目(81571405);江苏省自然科学基金项目(BK20161169);江苏省徐州市科学技术社会发展项目(KC20092);江苏省新药研究与临床药学重点实验室开放课题。

摘　　要：目的比较体外受精—胚胎移植(IVF-ET)中分别采用长效长方案(EFLL)、短效长方案(MLSL)、拮抗剂方案(GnRH-ant)三种促排卵方案以及采用重组人卵泡刺激素(rFSH)、尿促性素(HMG)、rFSH+重组人黄体生成素(rLH)三组促性腺激素(Gn)用药方案的波塞冬(POSEIDON)标准组4卵巢低反应(POR)患者的促排卵情况及妊娠结局。方法回顾性选取POSEIDON标准组4 POR患者175例,共294个IVF周期。根据促排卵方案的使用分为EFLL组(15个周期)、MLSL组(41个周期)、GnRH-ant组(238个周期),根据Gn的使用分为rFSH组(32个周期)、HMG组(203个周期)、rFSH+rLH组(59个周期)。各组分别采用相应的促排卵方案及Gn治疗,后续进行IVF-ET移植。观察并记录各组促排卵情况(Gn总量、Gn天数、获卵数、成熟MⅡ卵数)及妊娠结局(受精率、可移植胚胎数、优质胚胎数、全胚冷冻率、胚胎种植率、单周期临床妊娠率、单周期活产率及流产率)。结果与MLSL、GnRH-ant组比较,EFLL组Gn天数、Gn总量、获卵数、成熟MⅡ卵数、可移植胚胎数多,单周期临床妊娠率、流产率、胚胎种植率高,全胚冷冻率低(P均<0.05)。与GnRH-ant组比较,EFLL组、MLSL组单周期活产率有升高趋势(P=0.059),且MLSL组单周期活产率最高。与HMG组、rFSH+rLH组比较,rFSH组获卵数、成熟MⅡ卵数、可移植胚胎数、优质胚胎数、流产率高;与rFSH组、rFSH+rLH组比较,HMG组获卵数少,全胚冷冻率高,种植率、单周期临床妊娠率、单周期活产率低;与rFSH组、HMG组比较,rFSH+rLH组胚胎种植率、单周期临床妊娠率、单周期活产率高,流产率低(P均<0.05)。结论POSEIDON标准组4 POR患者促排卵方案采用MLSL促排卵效果较好,IVF-ET妊娠结局较好,可作为该人群的优选方案。在促排卵过程中,采取rFSH+rLH联合用药可能获得较好的妊娠结局。Objective To compare the clinical effects of the early-follicular phase long-acting GnRH agonist long protocol(EFLL),mid-luteal phase short-acting GnRH agonist long protocol(MLSL),and gonadotropin-releasing hormone antagonist protocol(GnRH-ant)and recombinant human follicle-stimulating hormone(rFSH),human menopausal gonadotrophin(HMG),rFSH+recombinant luteinizing hormone(LH)(rFSH+rLH)regimens on in vitro fertilization-embryo transfer(IVF-ET)outcomes in poor ovarian response(POR)patients with Patient Oriented Strategies Encompassing Individualized Oocyte Number(POSEIDON)group 4.Methods Totally 175 POSEIDON group 4 patients were enrolled in this study,including 294 IVF cycles.According to the ovulation induction,they were divided into three groups:EFLL group(15 cycles),MLSL group(41 cycles),and GnRH-ant group(238 cycles).According to gonadotrophins,they were divided into three groups:rFSH group(32 cycles),HMG group(203 cycles)and rFSH+rLH(59 cycles).Patients in each group were treated with their corresponding ovulation induction and Gn treatment,and then underwent IVF-ET.The ovulation induction(the total amount of Gn,Gn days,the number of oocyte retrieved and the number of MⅡ oocytes)and the pregnancy outcomes(fertilization rate,transferable embryos,high-quality embryos and whole embryo freezing rate,embryo implantation rate,the clinical pregnancy rate per cycle,the live birth rate per cycle,and abortion rate)of these groups were observed and recorded.Results Compared with the MLSL and GnRH-ant groups,the total amount of Gn used and Gn days,the number of oocyte retrieved,the number of MⅡ oocytes,the number of Day3 transferable embryos,the clinical pregnancy rate per cycle,the abortion rate per cycle,and the embryo implantation rate were higher,but the whole embryo freezing rate was lower in the EFLL group(all P<0.05).The live birth rate per cycle was higher in the EFLL and MLSL groups as compared with that of the GnRH-ant group(P=0.059),and it was the highest in the MLSL group.Compared with the rFSH and rFSH+rL

关 键 词：波塞冬标准组4 长效长方案 短效长方案 拮抗剂方案 重组人卵泡刺激素 重组人黄体生成素 尿促性素 

分 类 号：R737.31[医药卫生—肿瘤]