比较卵泡期长效长方案和拮抗剂方案在不孕伴肥胖人群中的应用效果  

Comparison of the early follicular long-term protocol and antagonist protocol in Obese infertility patients

作　　者：潘丹 杨杰 王婷 范丽娟 周寒鹰 师娟子 李娜 PAN Dan;YANG Jie;WANG Ting;FAN Li-juan;ZHOU Han-ying;SHI Juan-zi;Li Na(Northwest Women’s and Children’s Hospital,Xi’an 710004)

机构地区：[1]西北妇女儿童医院,西安710004

出　　处：《生殖医学杂志》2024年第3期330-336,共7页Journal of Reproductive Medicine

基　　金：2023年度生殖医学中青年医生研究项目(BJHPA-2023-SZHYXZHQN-003)。

摘　　要：目的探究卵泡期长效长方案和拮抗剂方案在不孕伴肥胖人群中的新鲜周期妊娠结局。方法回顾性分析2021年1月至2022年12月期间在西北妇女儿童医院行IVF/ICSI助孕且体质量指数(BMI)≥30 kg/m^(2)的患者资料,根据促排卵方案的不同分为卵泡期长效长方案组(n=170)及拮抗剂方案组(n=374),比较两组间的基本资料、促排卵情况以及新鲜周期移植后的临床妊娠结局,并对影响妊娠结局的主要因素[年龄、BMI、是否合并多囊卵巢综合征(PCOS)、促排卵方案等]行Logistic回归分析。结果与卵泡期长效长方案组比较,拮抗剂方案组的患者年龄大、原发不孕占比少、不孕年限时间短、基础卵泡刺激素(FSH)水平高、第1周期促排卵占比少、合并PCOS及胰岛素抵抗占比少、Gn使用天数短、获卵数少、可用胚胎数少以及卵巢过度刺激综合征(OHSS)发生率少,且差异均有统计学意义(P<0.05)。两组间BMI、窦卵泡数(AFC)、Ⅱ型糖尿病比、总Gn剂量、HCG日雌二醇(E_(2))和孕酮(P)水平及内膜厚度、优质胚胎数、无可移植胚胎率、新鲜周期的移植胚胎个数及移植囊胚占比均无显著性差异(P>0.05)。两组间的新鲜周期移植妊娠结局及新生儿结局也均无显著性差异(P>0.05)。在校正了年龄、BMI、合并PCOS等相关混杂因素后,Logistic回归分析显示,年龄是活产率的独立影响因素(P<0.05),不同促排卵方案不影响患者新鲜周期活产率、妊娠期糖尿病及妊娠期高血压疾病的发生率。结论不孕症伴肥胖患者采用卵泡期长效长方案和拮抗剂方案可获得相似的新鲜周期移植临床妊娠结局;拮抗剂方案可减少患者Gn使用时间,是不孕症伴肥胖患者可优先选择的方案。但考虑肥胖患者妊娠后围产期不良事件风险增高,临床工作中对于行IVF/ICSI治疗的患者仍应重视控制BMI。Objective:To investigate the clinical effects and pregnancy outcomes of the early follicular long-term protocol and antagonist protocol in the treatment of obese infertility patients.Methods:This study was a retrospective cohort study.The data of patients with body mass index(BMI)≥30 kg/m^(2) who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)in Northwest Women and Children’s Hospital from January 2021 to December 2022 were collected.According to the different ovulation induction schemes,they were divided into two groups:long-term ovulation scheme group(n=170)and antagonist scheme group(n=374).The basic characteristics,ovulation induction and fresh cycle transplantation were compared between the two groups,and the main factors for pregnancy outcome such as age,BMI,polycystic ovary syndrome(PCOS),transfer of high-quality embryos,transfer of high-quality blastocysts and ovulation-stimulating protocol were evaluated by logistic multivariate analysis.Results:The patients in the antagonist group were older,less in primary infertility,shorter in infertility years,higher in basic follicle-stimulating hormone(bFSH),less in ovulation induction in the first cycle,less in combined with PCOS and insulin resistance,shorter in days of gonadotropin(Gn)use,less in the number of oocyte obtained,less in available embryos and less in ovarian hyperstimulation syndrome(OHSS)incidence,and the differences were statistically significant(P<0.05).There were no significant differences between the two groups in BMI,antral follicle count(AFC)and the prevalence of typeⅡdiabetes,total Gn doses,levels of estradiol(E_(2))and progesterone(P)as well as endometrial thickness on human chorionic gonadotropin(hCG)day,the number of high-quality embryos,the rate of unavailable transferred embryos,the number of transferred embryos in fresh cycle,and the proportion of transferred blastocysts(P>0.05).There were no significant differences in pregnancy outcomes and neonatal outcomes between the two groups(P>0.05).After adjus

关 键 词：卵泡期长效长方案 拮抗剂方案 体质量指数 IVF/ICSI 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]