拮抗剂方案与卵泡期长方案在卵巢高反应患者中的应用比较  

Comparison of antagonist protocol and GnRH agonist long protocol in follicular phase in high ovarian responders

作　　者：卢娜 李菲 屈鹏飞 师娟子 田莉 LU Na;LI Fei;QU Peng-fei;SHI Juan-zi;TIAN Li(Northwest Women’s and Children’s Hospital,Xi’an 710000)

机构地区：[1]西北妇女儿童医院,西安710000

出　　处：《生殖医学杂志》2022年第8期1055-1060,共6页Journal of Reproductive Medicine

基　　金：西北妇女儿童医院院内科研项目(2020LQ02)。

摘　　要：目的探讨拮抗剂方案和卵泡期长方案在卵巢高反应患者助孕治疗中的临床应用效果。方法采用回顾性队列研究分析2019年1月至2020年6月在我院生殖中心行IVF/ICSI-ET助孕治疗的卵巢高反应患者的临床资料(共864个周期),根据促排卵方案的不同分为拮抗剂组(采用拮抗剂方案促排,112个周期)和卵泡期长方案组(采用卵泡期长方案促排,752个周期),比较两组患者的一般情况、新鲜周期和第1次解冻移植周期移植D3胚胎和移植D5囊胚的临床结局及达活产时间。结果两组患者的平均年龄、体质量指数(BMI)、基础黄体生成素(bLH)比较均无显著性差异(P均>0.05);拮抗剂组的bFSH水平显著高于卵泡期长方案组(P<0.05),AFC显著低于卵泡期长方案组(P<0.05)。两组患者的Gn用量、获卵数、2PN数比较,均无显著性差异(P>0.05);拮抗剂组的Gn天数、预防卵巢过度刺激综合征(OHSS)周期取消率显著低于卵泡期长方案组(P<0.05),可用胚胎数及优质胚胎数显著高于卵泡期长方案组(P<0.05)。新鲜周期移植中,卵泡期长方案组的临床妊娠率及活产率略高于拮抗剂组,但差异无统计学意义(P>0.05);而拮抗剂组的达活产时间显著短于卵泡期长方案组(P<0.05)。第1次FET周期的D3胚胎组内,卵泡期长方案组和拮抗剂组的种植率、临床妊娠率及活产率无显著性差异(P>0.05);卵泡期长方案组的流产率略高于拮抗剂组,达活产时间略长于拮抗剂组,但差异均无统计学意义(P均>0.05);D5囊胚组内,卵泡期长方案组的种植率、临床妊娠率、流产率及活产率均略高于拮抗剂组,但差异均无统计学意义(P均>0.05);拮抗剂组的达活产时间较卵泡期长方案组显著缩短(P<0.05)。结论拮抗剂方案应用于卵巢高反应患者,行鲜胚移植或FET均可以获得与卵泡期长方案相似的临床妊娠率及活产率,且能明显缩短达活产时间。Objective:To investigate the clinical efficacy of GnRH antagonist(GnRH-ant)and GnRH agonist(GnRH-a)long protocol in follicular phase in high ovarian responders with IVF-ET.Methods:The retrospective cohort study was used to analyze the clinical data of patients with ovarian hyperresponsiveness who underwent IVF-ET treatment in the reproductive center of our hospital from January 2019 to June 2020 were retrospectively analyzed.According to the ovulation stimulation protocol,the patients were divided into GnRH-ant group(group A,112 cycles)and GnRH-a long protocol in follicular phase group(group B,752 cycles).The general condition,clinical outcome and time to live birth in fresh and first frozen-thawed embryo transfer(FET)cycles were compared between the two groups.Results:There were no significant differences in the age,body mass index(BMI),and basic LH level between the two groups(P>0.05).The basic FSH level in the group A was significantly higher,while AFC was significantly lower than that in the group B(P<0.05).There were no significant differences in Gn dosage,number of oocytes retrieved and number of 2 PN embryos between the two groups(P>0.05).The Gn days and the cycle cancellation rate of preventing ovarian hyperstimulation syndrome(OHSS)in the group A were significantly lower than those in group B(P<0.05),and the numbers of available embryos and high-quality embryos were significantly higher than those in group B(P<0.05).In fresh transfer cycle,the clinical pregnancy rate and live birth rate in group B were slightly higher than those in group A,but the difference was not significant(P>0.05).The time to live birth in group A was significantly shorter than that in group B(P<0.05).In the Day 3 embryo group of the first FET cycle,there were no significant differences in implantation rate,clinical pregnancy rate and live birth rate between group A and group B(P>0.05).The abortion rate of group B was slightly higher than that of group A,and the time to live birth was slightly longer than that of group A,but the dif

关 键 词：拮抗剂方案 卵泡期长方案 卵巢高反应 临床妊娠率 活产率 

分 类 号：R711.6[医药卫生—妇产科学]