长方案促排卵晚卵泡期孕酮升高对胚胎质量及累积活产率的影响  

Effects of progesterone elevation in late follicular phase of long-acting agonist long protocol on embryo quality and cumulative live birth rate

作　　者：李丹阳 张亚 董孝贞[2] 徐影 杨如雪 黄江笛 张俊韦 胡继君[1] 管一春[1] 孙丽君[1] Li Danyang;Zhang Ya;Dong Xiaozhen(Reproductive Medical Center,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052;Department of Ultrasound,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第三附属医院生殖医学中心,郑州450052 [2]郑州大学第三附属医院超声科,郑州450052

出　　处：《现代妇产科进展》2023年第8期595-599,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨早卵泡期长效长方案与黄体中期长效长方案促排卵晚卵泡期孕酮(P)升高对体外受精或卵胞浆内单精子注射(IVF/ICSI)助孕患者的胚胎质量及累积活产率的影响。方法:回顾分析2015年10月至2021年12月在郑州大学第三附属医院生殖中心行长方案促排卵的7001个周期的临床资料,依据HCG日血清P值分为两组,低孕酮组HCG日P<2.0ng/mL,高孕酮组HCG日P≥2.0ng/mL。采用线性回归与logistic回归分析校正混杂因素比较两组患者促排卵周期的实验室指标、首个胚胎移植周期的临床结局及累积活产率。结果:线性回归分析结果显示,高孕酮组的可利用胚胎率(β=-0.024,95%CI为-0.040~-0.009,P=0.002)、囊胚形成率(β=-0.067,95%CI为-0.093~-0.041,P<0.001)和首个胚胎移植周期的种植率(β=-0.078,95%CI为-0.114~-0.041,P<0.001)均显著低于低孕酮组。Logistic回归分析结果显示,高孕酮组首个胚胎移植周期的临床妊娠率(aOR=0.693,95%CI为0.579~0.829,P<0.001)、多胎妊娠率(aOR=0.622,95%CI为0.426~0.908,P=0.014)、活产率(aOR=0.624,95%CI为0.524~0.744,P<0.001)和累积活产率(aOR=0.587,95%CI为0.416~0.828,P=0.002)亦显著低于低孕酮组,而早期流产率(aOR=1.728,95%CI为1.217~2.455,P=0.002)与晚期流产率(aOR=2.045,95%CI为1.042~4.016,P=0.038)则显著高于低孕酮组。Logistic多元逐步回归分析结显示,晚卵泡期P提前上升的相关因素为年龄、抗苗勒管激素、促性腺激素总量、获卵数、HCG日黄体生成素水平和HCG日雌二醇水平。结论:长方案促排卵晚卵泡期P升高可能对患者的胚胎质量有负面影响,进而影响其累积活产率。在控制性超促排卵过程中,控制患者的促排卵药物剂量及获卵数,可减少因孕酮升高而对IVF/ICSI结局带来的不利影响。Objective:To investigate the effect of progesterone(P)elevation in late follicular phase of long-acting long protocol in early follicular phase or long-acting long protocol in middle luteal phase on embryo quality and cumulative live birth rate in patients undergoing in vitro fertilization or intracytoplasmic sperm injection(IVF/ICSI).Methods:The clinical data of 7001 patients who underwent long-acting agonist long protocol in the reproductive center of the third Affiliated Hospital of Zhengzhou University from October 2015 to December 2021 were retrospectively analyzed,and they were divided into two groups according to the serum P value on the HCG day.Patients with the serum P value<2.0ng/mL on the HCG day were in the low progesterone group,and those with the serum P value≥2.0ng/mL on the HCG day were in the high progesterone group.Linear regression analysis and logistic regression analysis were used to compare the laboratory indexes of the ovulation induction cycle,the clinical outcome of the first embryo transfer cycle and the cumulative live birth rate between the two groups after adjusting for confounders.Results:The available embryo rate(β=-0.024,95%CI=-0.040~-0.009,P=0.002)and blastocyst formation rate(β=-0.067,95%CI=-0.093~-0.041,P<0.001)of the high progesterone group were significantly lower than those in the low progesterone group.The implantation rate(β=-0.078,95%CI=-0.114~-0.041,P<0.001),clinical pregnancy rate(aOR=0.693,95%CI=0.579~0.829,P<0.001),multiple pregnancy rate(aOR=0.622,95%CI=0.426~0.908,P=0.014),live birth rate(aOR=0.624,95%CI=0.524~0.744,P<0.001)in the high progesterone group during the first embryo transfer cycle and the cumulative live birth rate(aOR=0.587,95%CI=0.416~0.828,P=0.002)of the high progesterone group were also significantly lower than those in the low progesterone group,while the early miscarriage rate(aOR=1.728,95%CI=1.217~2.455,P=0.002)and late miscarriage rate(aOR=2.045,95%CI=1.042~4.016,P=0.038)were significantly higher than those in the low progesterone group.Logis

关 键 词：晚卵泡期 孕酮 胚胎质量 累积活产率 早卵泡期长效长方案 黄体中期长效长方案 

分 类 号：R715.5[医药卫生—妇产科学]