生长激素预处理应用于首次促排卵周期不理想患者的临床效果  

Clinical effect of growth hormone pretreatment on patients with unsatisfactory first ovulation cycle

作　　者：刘丽[1] 张顺吉 林戈[1,2] 龚斐 LIU Li;ZHANG Shun-ji;LIN Ge;GONG Fei(Institute of Reproductive&Stem Cell Engineering,Basic Medicine College,Central South University,Changsha 410006;Clinical Research Center for Reproduction&Genetics in Hunan Province,Reproductive&Genetic Hospital of CITIC-Xiangya,Changsha 410005)

机构地区：[1]中南大学生殖与干细胞工程研究所,长沙410006 [2]中信湘雅生殖与遗传专科医院,长沙410005

出　　处：《生殖医学杂志》2023年第4期521-528,共8页Journal of Reproductive Medicine

摘　　要：目的观察生长激素(GH)预处理应用于首次促排卵周期结局不理想患者的临床效果。方法回顾性分析2016年1月1日至2021年4月30日期间在中信湘雅生殖与遗传专科医院首次行IVF/ICSI助孕,且至少包含1次胚胎植入前非整倍体遗传学检测(PGT-A)周期患者的临床资料,共91例患者。所有患者首个促排卵周期结局不理想,于下一个月经周期前的6~8周使用GH预处理,连续使用至HCG日。采用自身对照的方法,比较前后两次助孕的促排卵情况及胚胎发育情况。结果整体分析发现,给予GH预处理后,全部91例患者本周期的获卵数、MⅡ卵数、双原核(2PN)卵数、囊胚数、优质囊胚数、整倍体囊胚数、囊胚形成率及整倍体囊胚率均显著高于上一周期(P<0.05)。对其中41例前后周期均采用拮抗剂方案促排卵患者的临床资料进行比较发现,本周期的囊胚数、优质囊胚数、整倍体囊胚数、囊胚形成率及整倍体囊胚率均显著高于上一周期(P<0.05)。将拮抗剂方案促排卵患者按照不同年龄进行分层分析发现,≥38岁组和<38岁组中,本周期的囊胚数及囊胚形成率均显著高于上一周期(P<0.05);并将≥35岁患者进一步细分为≥40岁组和35岁≤年龄<40岁组,结果发现≥40岁组中前后周期的促排卵及胚胎发育情况比较均无显著性差异(P>0.05),而35岁≤年龄<40岁组中本周期的囊胚数、优质囊胚数、整倍体囊胚数、囊胚形成率及整倍体囊胚率均显著高于上一周期(P<0.05)。又按照抗苗勒管激素(AMH)水平不同进行分层分析发现,AMH>1.2 ng/ml组中本周期的囊胚数、优质囊胚数、整倍体囊胚数、囊胚形成率及整倍体囊胚率均显著高于上一周期(P<0.05);AMH≤1.2 ng/ml组中本周期的2PN卵数、囊胚数显著高于上一周期(P<0.05)。结论对于IVF/ICSI周期中无获卵/无囊胚形成或PGT-A周期结局不好的<40岁、AMH>1.2 ng/ml的患者,在促排卵过程中添加GH预处理可�Objective:To observe the clinical effect of growth hormone(GH)pretreatment in patients with poor outcome of the first controlled ovarian stimulation(COS)cycle.Methods:The clinical data of 91 patients who underwent IVF/ICSI assisted pregnancy for the first time and including at least one preimplantation aneuploidy genetic test(PGT-A)cycle at the Reproductive&Genetic Hospital of CITIC-Xiangya in Changsha,from January 1,2016 to April 30,2021 were retrospectively analyzed.The outcome of the first COS cycle of all patients was not ideal.GH pretreatment was used 6 to 8 weeks before the next menstrual cycle,and it was used continuously until the HCG injection day.A self-control study method was adopted to compare the status of COS and embryo development before and after GH pretreatment COS cycles.Results:Overall analysis showed that after GH pretreatment in the current cycle,the number of oocytes retrieved,MⅡoocytes,double pronucleus(2PN)oocytes,blastocysts,high-quality blastocysts and euploid blastocysts,blastocyst formation rate and euploid blastocyst rate of all 91 patients were significantly higher than those in the previous cycle(P<0.05).In 41 patients who were treated with GnRH-antagonist protocol in both cycles,it was found that the number of blastocysts,high-quality blastocysts&euploid blastocysts,the rates of blastocyst formation&euploid blastocyst in the current cycle were significantly higher than those in the previous cycle(P<0.05).Stratified analysis of the patients with GnRH-antagonist protocol according to different ages(≥38 and<38 years old)found that the number of blastocysts and the blastocyst formation rate in the current cycle were significantly higher than those in the previous cycle in both age groups(P<0.05).The patients≥35 years old were further divided into≥40 years old group and 35 years≤age<40 years group.The results showed that there was no significant difference in the outcomes of COS and embryo development between the previous cycle and the current cycles in the≥40 years old gro

关 键 词：生长激素 辅助生殖 囊胚数 整倍体 非整倍体 

分 类 号：R711.6[医药卫生—妇产科学]