GnRH拮抗剂方案新鲜周期胚胎移植后妊娠结局的影响因素分析  

Analysis of influencing factors of pregnancy outcomes in fresh embryo transfer cycle with GnRH antagonist protocol

作　　者：秦琰 付浩 张宝丽 杨志娟 苗绘 孙宁 王健 胡春秀 QIN Yan;FU Hao;ZHANG Bao-li;YANG Zhi-juan;MIAO Hui;SUN Ning;WANG Jian;HU Chun-xiu(Characteristic Medical Center of the Chinese people’s Armed Police Force,Tianjin 300160)

机构地区：[1]中国人民武装警察部队特色医学中心生殖医学科,天津300160

出　　处：《生殖医学杂志》2024年第12期1564-1570,共7页Journal of Reproductive Medicine

摘　　要：目的探讨GnRH拮抗剂方案新鲜周期胚胎移植后妊娠结局的影响因素。方法回顾性分析2020年6月至2023年6月于我中心生殖医学科行IVF/ICSI-ET助孕治疗患者的临床资料。根据纳排标准,共纳入713个周期;根据患者是否获得临床妊娠分为妊娠组(n=364)和未妊娠组(n=349),比较两组患者的一般资料、促排卵及胚胎发育情况、妊娠结局的影响因素。结果本研究纳入的713个周期的整体临床妊娠率为51.1%(364/713),活产率41.4%(295/713),中重度卵巢过度刺激综合征(OHSS)发生率0.7%(5/713)。两组患者的一般资料比较无显著性差异(P>0.05)。两组间促性腺激素(Gn)启动剂量、Gn总量、拮抗剂总量、扳机日内膜厚度及获卵数、MⅡ卵数等比较均无显著性差异(P>0.05);妊娠组Gn启动FSH使用率(83.2%vs.76.2%)及扳机日A型子宫内膜率(87.4%vs.76.2%)显著高于未妊娠组(P<0.05);妊娠组Gn启动日雌二醇(E_(2))水平显著低于未妊娠组[(135.4±62.2)pmol/L vs.(146.4±69.5)pmol/L,P<0.05]。妊娠组患者的2PN数[(6.2±3.4)枚vs.(5.6±4.0)枚]、可利用胚胎数[(5.0±2.4)枚vs.(4.2±2.8)枚]、优胚数[(2.9±2.1)枚vs.(2.4±2.3)枚]、移植胚胎数[(1.8±0.3)枚vs.(1.7±0.4)枚]均显著高于未妊娠组(P<0.05)。多因素Logistic回归分析显示,启动日E_(2)水平、扳机日子宫内膜分型、可利用胚胎数及移植胚胎数是影响妊娠结局的独立因素(P<0.05)。结论患者行GnRH拮抗剂方案促排卵时,启动日雌激素水平较低、扳机日内膜分型A型、可利用胚胎数及移植胚胎数较多与新鲜周期胚胎移植后较高的临床妊娠率有关。Objective:To explore the influencing factors of pregnancy outcomes in fresh embryo transfer cycle with GnRH antagonist protocol.Methods:A retrospective study was conducted on clinical data of patients who underwent IVF/ICSI-ET in Characteristic Medical Center of Chinese People’s Armed Police Force from June 2020 to June 2023.According to the inclusion and exclusion criteria,a total of 713 cycles were included.According to whether clinically pregnant or not,the patients were divided into two groups as the pregnant group(n=364)and the non-pregnant group(n=349).The basic characteristics,ovulation induction and embryo development as well as factors influencing pregnancy outcomes were compared between two groups.Results:The overall clinical pregnancy rate of 713 cycles included in this study was 51.1%(364/713),with a live birth rate of 41.4%(295/713)and an incidence rate of OHSS of 0.7%(5/713).There were no significant difference in basic characteristics between the two groups(P>0.05).There were no significant differences in terms of gonadotropin(Gn)initiation dose,total amount of Gn use,total amount of antagonist use,endometrial thickness on the trigger day and the number of retrieved and MⅡoocytes between the two groups(P>0.05).The utilization rate of FSH for Gn initiation(83.2%vs.76.2%)and type A endometrium rate on the trigger day(87.4%vs.76.2%)in the pregnancy group were significantly higher than those in the non-pregnancy group(P<0.05).The estradiol(E_(2))level on the Gn initiation day in the pregnant group was significantly lower than that in the non-pregnant group[(135.4±62.2)pmol/L vs.(146.4±69.5)pmol/L,P<0.05].The number of pronuclear[2PNs,(6.2±3.4)vs.(5.6±4.0)],available embryos[(5.0±2.4)vs.(4.2±2.8)],high-quality embryos[(2.9±2.1)vs.(2.4±2.3)]and transferred embryos[(1.8±0.3)vs.(1.7±0.4)]in the pregnant group was significantly higher than that in the non-pregnant group(P<0.05).Multivariate logistic regression analysis showed that E_(2) level on the initiation day,the endometrial type on the t

关 键 词：GnRH拮抗剂方案 胚胎移植 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]