基于P/E2水平分析不同剂量HMG方案与妊娠结局的关系  

The relationship between different doses and timing of HMG regiments and pregnancy outcomes based on P/E2 level

作　　者：罗薇薇 林忠 李洁 王书佳 陈一君 覃华梅 LUO Weiwei;LIN Zhong;LI Jie;WANG Shujia;CHEN Yijun;QIN Huamei(Department of Reproductive Medicine,The Reproductive Hospital of Guangxi Zhuang Autonomous Region,Nanning 530029,China)

机构地区：[1]广西壮族自治区生殖医院生殖医学科,广西南宁530029

出　　处：《中国妇产科临床杂志》2024年第5期449-452,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20211543)。

摘　　要：目的探讨不同剂量绝经期促性腺激素(HMG)方案对不孕症中发生卵巢慢反应的患者妊娠结局的影响。方法选取2019年1月至2022年12月广西壮族自治区生殖医院收治的268例不孕症中发生卵巢慢反应的患者进行研究,对患者及时添加HMG,最后依据患者使用外源性促性腺激素(Gn)的最高剂量分为A(最高剂量225单位)、B(最高剂量300单位)、C(最高剂量375单位)、D(最高剂量450单位)四组。分析各组患者的年龄、方案类型、不孕年限、不孕类别、体质量指数(BMI)、抗苗勒激素(AMH)、基础窦卵泡数;启动Gn量、启动日促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P),Gn使用时间、Gn使用总量、HCG日的LH、E2、孕酮及P/E2水平,HCG日的内膜厚度和形态;获卵数、MII卵率、D3优胚率、可利用囊胚形成率、中重度卵巢过度刺激综合征(OHSS)发生率、胚胎种植率及临床妊娠率。结果D组HCG日E2、HCG日P水平明显高于A、B、C组,B组HCG日P/E2水平明显低于A、C、D组,B组内膜形态为A型占比最高,D组Gn使用总量最高(P<0.05);B组胚胎种植率及临床妊娠率较其他各组均更高(P<0.05)。P/E2水平为(0.50±0.04)×103时妊娠结局最优。结论添加HMG至外源性促性腺激素(Gn)最高剂量300单位的方案对妊娠结局的改善有一定价值。Objective To investigate the effect of different doses of menopausal gonadotropin(HMG)on pregnancy outcomes in infertility patients with suboptimal ovarian response.Methods A total of 268 infertility patients with suboptimal ovarian response admitted to Guangxi Zhuang Autonomous Region reproductive hospital from January 2019 to December 2022 were included.HMG was added in time when patients had a slow response.Furthermore,according to the highest dose of exogenous gonadophin(Gn),patients were divided into 4 groups:A(the highest dose of 225 units),B(the highest dose of 300 units),C(the highest dose of 375 units)and D(the highest dose of 450 units).Age,regimen type,infertility years,infertility category,body mass index(BMI),anti-Mullerian hormone(AMH),and basal sinus follicle number were analyzed.Initiating Gn amount,follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P),Gn use time,total amount of Gn used,LH,E2,progesterone and P/E2 levels on HCG day,endometrial thickness and morphology on HCG day;Number of eggs obtained,MII egg rate,D3 fine embryo rate,available blastocyst formation rate,incidence of moderate to severe ovarian hyperstimulation syndrome(OHSS),embryo implantation rate,clinical pregnancy rate.Results The P levels of E2 and HCG on HCG day in group D were significantly higher than those in groups A and C,and the P/E2 levels on HCG day of group B were significantly lower than those in groups A,C and D.The proportion of endometrial morphology of type A in group B was the highest,and the total amount of Gn in group D was the highest(P<0.05).The implantation rate and clinical pregnancy rate of group B were higher than those of other groups(P<0.05).When P/E2 level was(0.50±0.04)×103,the pregnancy outcome was optimal.Conclusion Adding HMG to the protocol with the highest dose of Gn at 300 units has a certain value in improving pregnancy outcomes.

关 键 词：孕酮 雌二醇 绝经期促性腺激素 卵巢慢反应 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]