促性腺激素使用时长对促性腺激素释放激素激动剂长方案体外受精-胚胎移植妊娠结局的影响  

Effect of the duration of gonadotropin stimulation on pregnancy outcome of in vitro fertilization and embryo transfer with GnRH-a long protocol

作　　者：张红霞 杨硕[1] 田甜 甄秀梅[1] Zhang Hongxia;Yang Shuo;Tian Tian;Zhen Xiumei(Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital,State Key Laboratory of Female Fertility Promotion,National Clinical Research Center for Obstetrics and Gynecology(Peking University Third Hospital),Key Laboratory of Assisted Reproduction(Peking University),Ministry of Education,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科生殖医学中心,女性生育力促进全国重点实验室,国家妇产疾病临床医学研究中心(北京大学第三医院),辅助生殖教育部重点实验室(北京大学),北京市生殖内分泌与辅助生殖技术北京市重点实验室,北京100191

出　　处：《中华生殖与避孕杂志》2024年第9期898-905,共8页Chinese Journal of Reproduction and Contraception

基　　金：国家重点研发计划项目(2022YFC2703800)。

摘　　要：目的:探讨黄体期促性腺激素释放激素激动剂(gonadotrophin-releasing hormone agonist,GnRH-a)长方案中促性腺激素(gonadotrophin,Gn)使用时长对体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)新鲜周期及解冻周期妊娠结局的影响。方法:回顾性队列研究分析2017年1月至2021年12月期间在北京大学第三医院妇产科生殖医学中心采用长方案行IVF/ICSI助孕患者的临床资料,根据控制性促排卵过程中Gn使用时长分为两组(Gn使用时长>15 d组,1198例;Gn使用时长≤15 d组,4792例),比较两组一般资料及在新鲜周期及解冻周期妊娠结局情况。采用多因素二分类logistic回归控制混杂因素,分析Gn使用时长与活产之间的关系。结果:新鲜周期中,Gn使用时长>15 d组无可移植胚胎率[16.4%(195/1187)]显著高于Gn使用时长≤15 d组[7.1%(338/4757),P<0.001],两组临床妊娠率、新鲜周期活产率、胚胎着床率和早期自然流产率相比差异均无统计学意义(均P>0.05)。在解冻周期中,两组临床妊娠率、活产率、胚胎着床率及早期流产率相比差异均无统计学意义(均P>0.05)。多因素二分类logistic回归分析排除混杂因素后,无论新鲜周期还是解冻周期中Gn使用时长与活产均无显著相关性(P=0.432和P=0.856)。结论:在黄体期长方案控制性促排卵过程中,与Gn使用时长≤15 d组相比,Gn使用时长>15 d组无可移植胚胎周期率增加,但一旦有可移植胚胎,新鲜周期和解冻周期妊娠结局相似,未发现通过影响子宫内膜容受性而影响新鲜周期妊娠结局。ObjectiveTo explore the effect of gonadotropin(Gn)stimulation duration on the pregnancy outcome in both fresh and frozen embryo transfer cycles in patients underwent in vitro fertilization(IVF)with gonadotrophin-releasing hormone agonist(GnRH-a)long protocol.MethodsA retrospective cohort study was used to analyze the clinical data of patients who underwent IVF/intracytoplasmic sperm injection(ICSI)with GnRH-a long protocol in Reproductive Medicine Center,Department of Obstetrics and Gynecology of Peking University Third Hospital from January 2017 to December 2021.According to the duration of Gn used in controlled ovarian stimulation,they were divided into two groups(Gn stimulation duration>15 d group,1198 cases;Gn stimulation duration≤15 d group,4792 cases),the general information and pregnancy outcome between the two groups were compared,and multiple factors binary logistic regression was used to control confounding factors and analyze the relationship between Gn stimulation duration and live birth.ResultsIn the fresh cycles,the rate of non-transplantable embryos in the group of Gn stimulation duration>15 d[16.4%(195/1187)]was significantly higher than that in the group of Gn stimulation duration≤15 d group[7.1%(338/4757),P<0.001],but there were no statistical differences in clinical pregnancy rate,live birth rate,implantation rate and early spontaneous abortion rate between the two groups(all P>0.05).In the frozen cycles,there were no statistical differences in clinical pregnancy rate,live birth rate,embryo implantation rate and early abortion rate between the two groups(all P>0.05).Multiple factors binary logistic analysis showed that there was no significant correlation between Gn stimulation duration and live birth in both fresh and frozen cycles(P=0.432,P=0.856).ConclusionCompared with the group of Gn stimulation duration≤15 d in patients with GnRH-a protocol,there was an increase in the rate of non-transplantable embryos in the fresh cycles in the group of Gn stimulation duration>15 d.However,once tr

关 键 词：促性腺激素 生殖技术 辅助 受精 体外 黄体期长方案 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]