GnRH拮抗剂使用时间对非多囊卵巢综合征鲜胚移植的影响  

Effect of GnRH antagonist administration duration on fresh embryo transfer in patients with non-polycystic ovary syndrome

作　　者：李旭[1] 刘林洪 陈颖[1] 王雅梅 罗银春 任凤 刘西茹[1] 陈莹[1] LI Xu;LIU Lin-hong;CHEN Ying;WANG Ya-mei;LUO Yin-chun;REN Feng;LIU Xi-ru;CHEN Ying(Reproductive Medicine Center,First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China)

机构地区：[1]重庆医科大学附属第一医院生殖医学中心,重庆400042

出　　处：《局解手术学杂志》2023年第4期308-312,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市自然科学基金面上项目(cstc2021jcyj-msxmX0506);重庆医科大学未来医学青年创新团队支持计划(W130)。

摘　　要：目的探讨拮抗剂固定方案中GnRH拮抗剂使用时间对非多囊卵巢综合征(PCOS)患者鲜胚移植周期临床结局的影响。方法回顾性分析于我院生殖医学中心行体外受精/卵胞浆内单精子注射(IVF/ICSI)治疗的279例不孕患者的临床资料。按照促排卵过程中GnRH拮抗剂使用时间,将患者分为拮抗剂使用时间≤3 d组和拮抗剂使用时间>3 d组。比较2组患者的基本临床特征、促排卵周期特征和鲜胚移植周期妊娠结局的差异。单因素和多因素Logistic回归分析鲜胚移植周期妊娠结局的影响因素。结果拮抗剂使用时间≤3 d组获卵率和周期取消率低于拮抗剂使用时间>3 d组(P<0.05),植入率和临床妊娠率均显著高于拮抗剂使用时间>3 d组(P<0.05)。2组间优胚率、第二次减数分裂中期(MⅡ)卵率、正常受精率、持续妊娠率、活产率、早期流产率差异无统计学意义(P>0.05)。单因素回归分析结果显示,拮抗剂使用时间>3 d与植入率[OR(95%CI):0.487(0.266~0.893),P=0.020]和临床妊娠率[OR(95%CI):0.400(0.191~0.840),P=0.015]降低有关,但是对持续妊娠率、活产率、早期流产率无影响。多因素Logistic分析显示,调整了混杂变量后,拮抗剂使用时间>3 d仍是导致临床妊娠率降低的重要因素[OR(95%CI):0.408(0.188~0.888),P=0.024]。结论非PCOS患者拮抗剂固定方案中GnRH拮抗剂使用时间>3 d与鲜胚移植周期胚胎植入率和临床妊娠率降低相关。Objective To investigate the effect of GnRH antagonist administration duration in the antagonist fixation protocol on the clinical outcomes of fresh embryo transfer cycle in patients with non-polycystic ovary syndrome(PCOS).Methods The clinical data of 279 infertile patients who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)in Reproductive Medicine Center of our hospital were retrospectively analyzed.According to the GnRH antagonist administration duration during ovulation induction,they were divided into the antagonist administration duration≤3 days group and the antagonist administration duration>3 days group.The basic clinical characteristics,ovulation induction cycle characteristics and pregnancy outcomes of fresh embryo transfer cycle were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to analyze the factors influencing the pregnancy outcomes of fresh embryo transfer cycle.Results The oocytes retrieved rate and the cycle cancellation rate in the antagonist administration duration≤3 days group were significantly lower than those in the antagonist administration duration>3 days group(P<0.05),and the implantation rate and clinical pregnancy rate were significantly higher than those in the antagonist administration duration>3 days group(P<0.05).There was no statistically significant difference in the optimal embryo rate,metaphaseⅡ(MⅡ)oocytes rate,normal fertilization rate,persistent pregnancy rate,live birth rate and early abortion rate between the two groups(P>0.05).Univariate regression analysis showed that the antagonist administration duration>3 days was associated with the decrease of the implantation rate[OR(95%CI):0.487(0.266 to 0.893),P=0.020]and the clinical pregnancy rate[OR(95%CI):0.400(0.191 to 0.840),P=0.015],but had no effect on persistent pregnancy rate,live birth rate and early abortion rate.Multivariate Logistic analysis showed that after adjusting for confounding variables,antagonist administration duration

关 键 词：拮抗剂方案 卵巢刺激 临床妊娠 体外受精 鲜胚移植 非多囊卵巢综合征 

分 类 号：R711.6[医药卫生—妇产科学]