黄体期长方案与拮抗剂方案应用于不明原因不孕患者IVF/ICSI-ET的助孕结局比较  

Comparison of IVF/ICSI-ET outcomes between luteal phase long protocol and GnRH antagonist protocol in patients with unexplained infertility

作　　者：邓燕锋 磨丹 贵银 马文红 杨一华 DENG Yan-feng;MO Dan;BI Yin;MA Wen-hong;YANG Yi-hua(Guangci Reproductive Medicine Research Center,the First Affiliated Hospital of Guangai Medical University,Nanning530021;Nanning Maternal&Children Health Care Hospital,Nanning 30011)

机构地区：[1]广西医科大学第一附属医院广西生殖医学研究中心,南宁530021 [2]广西南宁市妇幼保健院,南宁530011

出　　处：《生殖医学杂志》2023年第11期1615-1622,共8页Journal of Reproductive Medicine

基　　金：国家自然科学基金(81871172);广西自然科学基金(2019GXNSFFA245013)。

摘　　要：目的探讨黄体期长方案和拮抗剂方案应用于不明原因不孕(UI)患者体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕结局的差异。方法回顾性分析2016年1月至2022年7月于广西医科大学第一附属医院广西生殖医学研究中心首次行IVF/ICSI-ET助孕的278例UI患者(共278个周期)的临床资料。根据促排卵方案不同分为拮抗剂方案组(拮抗剂组,80个周期)和黄体期长方案组(长方案组,198个周期);又按照年龄不同分为≤35岁组(220个周期)和>35岁组(58个周期)。比较各组患者的基本资料、促排卵情况、胚胎发育实验室指标及首次鲜胚移植的妊娠结局等。结果拮抗剂组和长方案组患者的年龄、体质量指数(BMI)、不孕年限、基础卵泡刺激素(bFSH)、基础窦卵泡数(AFC)均无统计学差异(P>0.05)。拮抗剂组的Gn使用天数[(9.01±1.69)dvs.(11.03±1.71)dl、Gn总量[(1985.78±702.72)Uvs.(2361.78±803.66)U、HCG日内膜厚度[(10.37±1.78)mm vs.(11.10±1.82)mmJ、HCG日血清Ez水平[(10768.23±6426.70)pmol/L vs:(13090.65±7645.89)pmol/L]、获卵数[(12.75±7.09)枚vs.(14.88±7.65)枚]及预防卵巢过度刺激综合征(OHSS)周期取消率(11.3%vs.23.2%)均显著低于长方案组(P均<0.05),但两组中重度OHSS发生率比较无显著性差异(P>0.05)。拮抗剂组和长方案组的受精及胚胎发育指标比较均无显著性差异(P>0.05)。拮抗剂组鲜胚移植63个周期,长方案组鲜胚移植140个周期,长方案组的胚胎种植率(27.5%vs:24.6%)及临床妊娠率(43.6%vs:41.3%)稍高于拮抗剂组,生化妊娠率(4.3%vs.7.9%)及早期流产率(16.4%vs.19.2%)稍低于拮抗剂组,但均无显著性差异(P>0.05)。不同年龄分层比较中,<35岁患者中拮抗剂组和长方案组的胚胎种植率、生化妊娠率、临床妊娠率和早期流产率均无显著性差异(P 0.05);35岁患者中,长方案组的胚胎种植率、临床妊娠率稍高于拮抗剂组,生化妊娠率及早期流产率稍低于拮抗剂方案Objective:To explore the differences of IVF/ICSI-ET outcomes between luteal phase long protocol and GnRH antagonist protocol in patients with unexplained infertility(UI).Methods:The clinical data of 278 UI patients(278 cycles)who underwent the first IVF/ICSI-ET assisted pregnancy treatment in Reproductive Medicine Center of the First Affiliated Hospital of Guangxi Medical University from January 2016 to July 2022 were retrospectively analyzed.The cycles were divided into GnRH antagonist group(n=80)and luteal phase long protocol group(long protocol group,n=198)according to different ovulation induction protocol.The cycles were further divided into<35 years old group(n=220)and>35 years old group(n=58)according to age.The basic clinical data,ovulation induction status,embryo development,and pregnancy outcomes of the first fresh embryo transplantation were compared between the groups.Results:There were no significant differences in age,body mass index(BMI),infertility years,basal FSH and basal antral follicle count(AFC)between two groups(P>0.05).The days of Gn used[(9.01±1.69)days vs.(11.03±1.71)days],the total amount of Gn[(1985.78±702.72)U vs.(2361.78±803.66)UJ,the thickness of endometrium on the HCG day[(10.37±1.78)mm vs.(11.10±1.82)mm],the serum level E20n HCG day[(10768.23±6426.70)pmol/L vs.(13090.65±7645.89)pmol/LJ,the number of oocytes retrieved[(12.75±7.09)vs.(14.88±7.65)],and the cancellation rate for preventing OHSS(11.3%vs.23.2%)in the antagonist group were significantly lower than those in the long protocol group(P<0.05),but there was no significant difference in the incidence rate of moderate and severe OHSS between the two groups(P>0.05).There were no significant differences in fertilization rate and embryonic development indicators between the two groups(P>0.05).The antagonist group had 63 fresh embryo transfer cycles,and the long protocol group had 14o fresh embryo transfer cycles.The embryo implantation rate(27.5%vs.24.6%)and clinical pregnancy rate(43.6%vs.41.3%)of the long protocol group

关 键 词：不明原因不孕 抗剂方案 黄体期长方案 鲜胚移植 临床妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]