GnRH拮抗剂和激动剂方案中扳机日子宫内膜厚度对新鲜移植周期妊娠结局的影响  

Effects of trigger day endometrial thickness on pregnancy outcomes of fresh cycles in GnRH antagonist and agonist protocols

作　　者：窦倩[1] 马丽影[1] 李朋粉[1] 张丹[1] 许晓婷 项云改[1] 谭丽[1] DOU Qian;MA Liying;LI Pengfen;ZHANG Dan;XU Xiaoting;XIANG Yungai;TAN Li(Reproductive Medicine Center,the Second Affiliated Hospital,Zhengzhou University,Zhengzhou 450014)

机构地区：[1]郑州大学第二附属医院生殖医学中心,郑州450014

出　　处：《郑州大学学报（医学版）》2024年第2期186-191,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200421,LHGJ20210367)。

摘　　要：目的:研究促性腺激素释放激素拮抗剂(GnRH-ant)和激动剂(GnRH-a)方案中扳机日子宫内膜厚度(EMT)对新鲜移植周期妊娠结局的影响。方法:选择2015年1月至2021年12月在郑州大学第二附属医院生殖中心接受体外受精/卵胞浆内单精子显微注射(IVF/ICSI)助孕的患者,共纳入新鲜移植2 559周期,其中GnRH-ant方案298周期,GnRH-a方案2 261周期。根据扳机日EMT分为7~9 mm、>9~12 mm和>12 mm组。比较两种方案中3组的临床特征和妊娠结局。结果:GnRH-ant方案中EMT 7~9 mm组的临床妊娠率、持续妊娠率和活产率均低于其他两组(P<0.017);GnRH-a方案中扳机日EMT 7~9 mm组的临床妊娠率、持续妊娠率和活产率低于>9~12 mm组,>9~12 mm组低于>12 mm组(P<0.017)。Logistic回归分析结果显示扳机日EMT较高的患者临床妊娠、持续妊娠和活产增加[GnRH-ant方案:>9~12 mm组的OR(95%CI)分别为2.243(1.173~4.288)、3.995(1.891~8.438)、3.814(1.810~8.036),>12 mm组的OR(95%CI)分别为3.298(1.490~7.299)、6.637(2.742~16.065)、5.249(2.184~12.616);GnRH-a方案:>9~12 mm组的OR(95%CI)分别为1.561(1.266~1.925)、1.378(1.112~1.707)、1.448(1.166~1.798),>12 mm组的OR(95%CI)分别为2.266(1.747~2.940)、2.257(1.736~2.933)、2.254(1.732~2.933)]。结论:扳机日EMT增加可改善妊娠结局;无论是GnRH-ant方案,还是GnRH-a方案,随着扳机日EMT增加,妊娠成功率升高。Aim:To investigate the effects of trigger day endometrial thickness(EMT)on pregnancy outcomes of fresh cycles in gonadotropin-releasing hormone antagonist(GnRH-ant)and agonist(GnRH-a)protocols.Methods:Patients who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)assisted reproduction at the Reproductive Medicine Center of the Second Affiliated Hospital of Zhengzhou University from January 2015 to December 2021 were selected.A total of 2559 fresh embryo transfer cycles were selected,including 298 cycles of GnRH-ant protocol and 2261 cycles of GnRH-a protocol.The patients were allocated into 3 groups according to the EMT on the trigger day:7~9 mm,>9~12 mm,and>12 mm groups.Clinical characteristics and pregnancy outcomes of the patients in the 3 groups accepting 2 protocols were compared.Results:For the patients accepting the GnRH-ant protocol,the clinical pregnancy rate,ongoing pregnancy rate,and live birth rate in the EMT 7~9 mm group on the trigger day were lower than those in the other 2 groups(P<0.017).For the patients accepting GnRH-a protocol,the clinical pregnancy rate,ongoing pregnancy rate,and live birth rate in the EMT 7~9 mm group on the trigger day were lower than those in the EMT>9~12 mm group,and those in the EMT>9~12 mm group was lower than those in the EMT>12 mm group(P<0.017).Logistic regression analysis showed that patients with higher EMT on the trigger day had increased clinical pregnancy,ongoing pregnancy,and live birth[GnRH-ant protocol:OR(95%CI)for the EMT>9~12 mm group were 2.243(1.173-4.288),3.995(1.891-8.438),and 3.814(1.810-8.036),respectively,OR(95%CI)for the EMT>12 mm group were 3.298(1.490-7.299),6.637(2.742-16.065),and 5.249(2.184-12.616),respectively;GnRH-a protocol:OR(95%CI)for the EMT>9~12 mm group were 1.561(1.266-1.925),1.378(1.112-1.707),and 1.448(1.166-1.798),respectively,OR(95%CI)for the EMT>12 mm group were 2.266(1.747-2.940),2.257(1.736-2.933),and 2.254(1.732-2.933),respectively].Conclusion:Increasing EMT on the trigger day could improve pregnancy ou

关 键 词：控制性卵巢刺激 促性腺激素释放激素拮抗剂 促性腺激素释放激素激动剂 子宫内膜厚度 妊娠结局 辅助生殖 

分 类 号：R711.6[医药卫生—妇产科学]