生长激素改善预后不良患者IVF助孕结局的分析  

Analysis of growth hormone in improving IVF outcomes in patients with poor ovarian response

作　　者：唐奕[1,2] 胡嫦娥 彭扬琴 屈竞斐 林戈 龚斐[1,2] TANG Yi;HU Chang-e;PENG Yang-qin;QU Jing-fei;LIN Ge;GONG Fei(Institute of Reproduction and Stem Cell Engineering,Basic Medicine College,Central South University,Changsha 410078;Reproductive and Genetic Hospital of Citic-Xiangya,Changsha 410078)

机构地区：[1]中南大学生殖与干细胞工程研究所,长沙410078 [2]中信湘雅生殖与遗传专科医院,长沙410078

出　　处：《生殖医学杂志》2022年第9期1209-1215,共7页Journal of Reproductive Medicine

基　　金：湖南省自然科学基金(2018JJ6088)。

摘　　要：目的观察生长激素(GH)预处理辅助促排卵能否改善临床结局不良患者再次体外受精(IVF)助孕的妊娠结局。方法回顾性分析2019年12月至2021年7月在中信湘雅生殖与遗传专科医院因前次周期无获卵及胚胎质量差导致临床结局不良而采用GH干预的479例患者临床资料,GH预处理于促排启动日前两个月经周期的黄体中期开始直至扳机日,用药共7周时间。比较使用GH前后两个周期的促排卵情况、胚胎移植及临床结局等差异;并根据前一周期获卵数将患者分为3组:≤3枚组、4~9枚组和≥10枚组,比较3组患者使用GH后的获卵数及优胚数。结果(1)与使用GH前的周期相比,使用GH预处理后的周期获卵数[(8.81±6.33)vs.(7.83±5.01)]、D3优胚数[(1.86±2.38)vs.(0.97±1.63)]、D3优胚率[(0.40±0.59)vs.(0.24±0.45)]、D5囊胚数[(0.21±0.62)vs.(0.07±0.36)]、D6囊胚数[(0.59±1.23)vs.(0.25±0.65)]以及囊胚率[(0.16±0.32)vs.(0.08±0.21)]均显著上升(P<0.01),而Gn天数[(9.84±2.17)vs.(10.46±2.95),P<0.001]及总Gn总剂量[(2556.45±820.15)U vs.(2627.29±1004.89)U,P<0.05]显著减少;因胚胎因素取消周期率显著降低(36.60%vs.63.16%),临床妊娠率显著升高(39.88%vs.7.05%)(P<0.001);扳机日内分泌激素水平、扳机日内膜厚度及因卵母细胞因素取消周期率在使用GH预处理前后周期间无显著性差异(P>0.05)。(2)按照前一周期获卵数分组对比分析结果显示:≤3枚组用GH干预后获卵数[(4.03±3.64)vs.(1.74±1.06),P<0.001]显著增加,而4~9枚组和≥10枚组在GH干预前后获卵数无统计学差异(P>0.05);使用GH干预后,各组的D3优胚数均显著提高(P<0.001)。结论GH小剂量长程预处理辅助促排卵对前次周期无获卵或胚胎质量差导致临床结局不良患者来说,有助于增加获卵数、提高胚胎质量,改善妊娠结局。Objective:To observe whether growth hormone(GH)pretreatment in assisted ovulation induction can improve the pregnancy outcome of IVF in patients with adverse clinical outcomes.Methods:The clinical data of 479 patients who received GH pretreatment due to poor clinical outcomes caused by no oocyte retrieval or poor-quality embryo in the previous cycle in Reproductive and Genetic Hospital of CITIC-Xiangya from December 2019 to July 2021 were retrospectively analyzed.The patients received GH pretreatment started at the middle luteal phase of the two menstrual cycles before until the trigger day for 7 weeks.The differences of ovulation induction,embryo transfer and clinical outcome were compared between the cycles before and after GH treatment.According to the number of oocytes retrieved in the previous cycle,the patients were divided into three groups:≤3 oocytes group,4-9 oocytes group and≥10 oocytes group,the number of oocytes obtained and the number of good-quality embryos were compared among the three groups.Results:(1)The numbers of oocytes retrieved[(8.81±6.33)vs.(7.83±5.01)],the number of good-quality embryos on Day 3[(1.86±2.38)vs.(0.97±1.63)],the rate of good-quality embryos on Day 3[(0.40±0.59)vs.(0.24±0.45)],number of blastocysts on Day 5[(0.21±0.62)vs.(0.07±0.36)],and number of blastocysts on Day 6[(0.59±1.23)vs.(0.25±0.65)]and blastocyst rate were significantly increased in the GH pretreatment cycle compared with the previous cycle(P<0.01).while the days of gonadotropin(Gn)stimulation[(9.84±2.17)vs.(10.46±2.95),P<0.001]and the total Gn doses[(2556.45±820.15)U vs.(2627.29±1004.89)U,P<0.05]were significantly lower in GH pretreatment cycle.The cycle cancellation rate due to embryonic factors was significantly reduced(36.60%vs.63.16%,P<0.001),but the clinical pregnancy rate in GH pretreatment cycles was significantly increased(39.88%vs.7.05%,P<0.001)in GH pretreatment cycle.There were no significantly differences in hormone levels,endometrial thickness on the trigger day and cycle cancellati

关 键 词：生长激素 促排卵 预后不良 胚胎质量 体外受精 

分 类 号：R711.6[医药卫生—妇产科学]