三种扳机方式在多囊卵巢综合征患者拮抗剂方案促排卵中的临床应用  

Clinical application of GnRH antagonist protocol with three triggering strategies in patients with polycystic ovary syndrome

作　　者：李蓉 陈福锐 陈诗琪 秦娟 孔旭梅 吴洋 黄天红 龚衍 LI Rong;CHEN Fu-rui;CHEN Shi-qi;QIN Juan;KONG Xu-mei;WU Yang;HUANG Tian-hong;GONG Yan(Reproductive Medicine Centre,Sichuan Provincial Women's and Children's Hospital,the Affiliated Women's and children's Hospital of Chengdu Medical College,Chengdu 610045)

机构地区：[1]四川省妇幼保健院/成都医学院附属妇女儿童医院生殖中心,成都610045

出　　处：《生殖医学杂志》2023年第11期1623-1629,共7页Journal of Reproductive Medicine

基　　金：四川省妇幼保健协会妇幼医学科技创新课题(22FXZD01);四川省成都市卫生健康委医学科研课题(2022155);四川省医学会科研课题(S22015)。

摘　　要：目的探讨多囊卵巢综合征(PCOS)患者采用拮抗剂方案行控制性卵巢刺激(COS)过程中3种不同扳机方式的安全性和有效性。方法回顾性分析2019年1月至2023年3月在四川省妇幼保健院生殖中心行体外受精-胚胎移植(IVF-ET)助孕的329例PCOS患者(329个周期)的临床资料,按照不同扳机分为3组:A组,采用重组人绒毛膜促性腺激素(rHCG)扳机(n=125);B组,采用促性腺激素释放激素激动剂(GnRH-a)扳机(n=123);C组,采用GnRH-a联合HCG双扳机(n=81)。比较各组患者的基础资料、COS及胚胎发育情况、卵巢过度刺激综合征(OHSS)发生率、妊娠结局等。结果3组患者的基础资料比较均无显著性差异(P>0.05)。3组患者COS过程中重组人卵泡素(rFSH)总量、rFSH天数、扳机日LH及孕酮(P)水平、获卵数均无显著性差异(P>0.05);B组扳机日E2水平显著高于A、C组(P<0.05);A组的轻度、中度OHSS发生率显著高于B组(P<0.05)。3组患者的成熟卵率、正常受精率、D3胚胎形成率、D3优质胚胎形成率、囊胚形成率及优质囊胚率均无显著性差异(P>0.05)。3组患者不同移植周期(鲜胚移植及冻融胚胎移植)中移植日子宫内膜厚度、平均移植胚胎数、胚胎着床率、临床妊娠率、多胎妊娠率及早期流产率比较均无显著性差异(P>0.05)。结论GnRH-a扳机可以明显减少PCOS患者OHSS发生率,GnRH-a联合HCG双扳机有降低OHSS发生的趋势;双扳机能增加鲜胚移植机会,且并未明显降低鲜胚移植及冻融胚胎移植的成功率。Objective:To explore the effectiveness and safety of three triggering strategies during GnRH antagonist protocol in patient with polycystic ovary syndrome(PCOS).Methods:The data of 329 patients(329 IVF-ET cycles)in Reproductive Medicine Centre,Sichuan Provincial Women's and Children's Hospital from January 2019 to March 2023 were analyzed retrospectively.The patients were divided into three groups based on the types of the trigger method:the patients in group A(n=125)were given recombination HCG(rHCG),the patients in group B(n=123)were given GnRH agonist(GnRH-a)and the patients in group C(n=81)were given GnRH-a combined with HCG.The general characteristics,controlled ovarian stimulation(COS)and embryonic development status,incidence rate of ovarian hyper-stimulation syndrome(OHSS)and pregnancy outcomes were compared among the three groups.Results:There was no significant difference in basic data among the three groups(P>0.05).There were no significant differences in the total amount and days of recombinant human FSH(rFSH)used,LH and progesterone levels on trigger day,and number of oocytes retrieved among the three groups during COS(P>0.05).The E,levels on the trigger day in group B were significantly higher than those in groups A and C(P<0.05).The incidence rate of mild and moderate OHSS in group A was significantly higher than that in group B(P<0.05).There were no significant differences in the mature oocyte rate,normal fertilization rate,Day 3 embryo formation rate,Day 3 high-quality embryo formation rate,blastocyst formation rate,and high-quality blastocyst rate among the three groups(P>0.05).There were no significant differences in endometrial thickness,average number of embryos transferred,embryo implantation rate,clinical pregnancy rate,multiple pregnancy rate,and early abortion rate among the three groups in different transfer cycles(fresh embryo transfer and frozen-thawed embryo transfer)(P>0.05).Conclusions:GnRH-a trigger can effectively reduce the occurrence of OHSS.The dual triggers with GnRH-a&HCG has

关 键 词：多囊卵巢综合征 GnRH拮抗剂方案 HCG扳机 GnRH激动剂扳机 双扳机 

分 类 号：R711.6[医药卫生—妇产科学]