不同年龄段人群三种促排卵方案胚胎发育及临床结局比较  

Comparative Study of the Embryo Development and Clinical Outcomes of 3 Ovarian Stimulation Protocols in Different Age Groups

作　　者：范咏琪 张文香[1] 章志国[1] FAN Yongqi;ZHANG Wenxiang;ZHANG Zhiguo(Reproductive Medicine Center,Department of Obstetrics and Gynecology,The First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院妇产科生殖中心,合肥230032

出　　处：《四川大学学报（医学版）》2024年第3期580-587,共8页Journal of Sichuan University(Medical Sciences)

基　　金：国家重点研发计划(No.2022YFC2703000);国家自然科学基金(No.82071724)资助。

摘　　要：目的 比较不同年龄段人群使用促性腺激素释放激素(gonadotropin releasing hormone, GnRH)拮抗剂方案、GnRH激动剂长方案与早卵泡期长方案进行体外受精(IVF)过程中的胚胎发育及临床结局情况。方法 回顾性纳入2021年1月–2023年2月期间收治的患者。(1)在总人群中,对三种促排方案[拮抗剂方案组(4 173例),激动剂长方案组(2 410例)与早卵泡长方案组(341例)]患者的基本情况、胚胎发育情况及临床结局进行比较;(2)将总人群划分为三个年龄段[<30岁(2 576例),30~35岁(3 249例),>35岁(1 099例)],并在此基础上,进一步对三种促排方案进行比较。分别比较<30岁、30~35岁、>35岁人群中使用三种促排方案的胚胎发育情况及临床结局。结果 在总人群中,激动剂长方案组的获卵数高于拮抗剂方案组[(13.85±7.162)个vs.(13.36±7.862)个,P=0.022 4]与早卵泡长方案组[(13.85±7.162)个vs.(11.86±6.802)个,P<0.000 1];拮抗剂方案组的促性腺激素(gonadotropin, Gn)启动量、Gn使用天数均低于其余两组(P<0.05);拮抗剂方案组的囊胚形成率高于激动剂长方案组(64.91%vs. 62.35%,P<0.000 1),同时也高于早卵泡长方案组(64.91%vs. 61.18%,P=0.000 1),而三种促排方案临床妊娠率、活产率差异无统计学意义(P>0.05);(2)在<30岁人群中,拮抗剂方案组的囊胚形成率高于激动剂长方案组(66.12%vs. 63.33%,P<0.000 1)与早卵泡长方案组(66.12%vs. 62.13%,P=0.009 4);在30~35岁人群中,拮抗剂方案组的囊胚形成率高于激动剂长方案组(64.88%vs. 62.93%,P=0.000 9)与早卵泡长方案组(64.88%vs.60.39%,P=0.001 1);在>35岁人群中,拮抗剂方案组的囊胚形成率高于激动剂长方案组(59.83%vs. 56.51%,P=0.009 3),而与早卵泡长方案组差异无统计学意义(P>0.05)。在三个年龄段人群中,三种促排方案的临床妊娠率、活产率、胎儿体质量及评分差异均无统计学意义(P>0.05)。结论 拮抗剂方案能减少促排时间、促排卵Gn剂量,增强Objective The main purpose of this study is to compare the embryo development and clinical outcomes of women in different age groups undergoing in vitro fertilization(IVF)processes using gonadotrophin-releasing hormone(GnRH)antagonist protocol,GnRH agonist long protocol,and early follicular phase protocol.We aim to provide reliable reference for future clinical treatments.Methods We conducted a detailed analysis of patients who underwent treatment between January 2021 and February 2023.1)In the overall patient population,we comprehensively compared the basic characteristics,the embryo development,and the clinical outcomes of patients treated with three different ovarian stimulation protocols,including the GnRH antagonist protocol group(n=4173),the agonist long protocol group(n=2410),and the early follicular phase long protocol group(n=341).2)We divided the overall population into three age groups,one group for patients under 30 years old(n=2576),one for patients aged 30-35(n=3249),and one for patients older than 35 years old(n=1099).Then,we compared the three stimulation protocols based on the group division.We separately compared the embryo development and clinical outcomes of patients using the three stimulation protocols in the under 30 years old,the 30-35 years old,and the over 35 years old age groups.With this analysis,we aimed to explore the response of different age groups to different stimulation protocols and their impact on the success rate of IVF.Results 1)In the overall population,we found that the average number of oocytes retrieved in the GnRH agonist long protocol group was significantly higher than that in the GnRH antagonist protocol group([13.85±7.162]vs.[13.36±7.862],P=0.0224),as well as the early follicular phase long protocol group([13.85±7.162]vs.[11.86±6.802],P<0.0001).Patients in the GnRH antagonist protocol group not only had a significantly lower starting dose of gonadotrophin(Gn)compared to the other two groups(P<0.05)but also had a significantly lower number of days of Gn use(P<0.0

关 键 词：促性腺激素释放激素拮抗剂 促性腺激素释放激素激动剂 胚胎发育 

分 类 号：R714.8[医药卫生—妇产科学]