不同COH方案对卵巢储备功能减退的子宫内膜异位症患者累积活产率的影响  

Effect of different ovarian stimulation protocols on the cumulative live birth rates of endometriosis patients with diminished ovarian reserve

作　　者：王冬雪 包莉莉 张洁 杨波 WANG Dong-xue;BAO Li-li;ZHANG Jie;YANG Bo(Reproductive Center,Department of Obstetric&Gynecology,the 980 th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang050082)

机构地区：[1]中国人民解放军联勤保障部队第九八〇医院妇产科生殖中心,石家庄050082

出　　处：《生殖医学杂志》2024年第12期1594-1601,共8页Journal of Reproductive Medicine

基　　金：2023年度河北省医学科学研究课题计划(20231293)。

摘　　要：目的 比较促性腺激素释放激素(GnRH)拮抗剂方案和GnRH激动剂长方案用于卵巢型子宫内膜异位症(EMS)合并卵巢储备功能减退(DOR)患者促排卵时,对累积活产率的影响。方法 回顾性分析2022年6月至2023年6月于我院妇产科生殖中心首次行IVF/ICSI-ET助孕、采用拮抗剂方案及长方案促排卵的卵巢型EMS合并DOR患者的临床资料,共218个取卵周期。按照年龄不同将纳入对象分为≤35岁组(139个周期)和>35岁组(79个周期),每组又根据促排卵方案不同分为拮抗剂组和长方案组两个亚组。比较各组患者的一般资料、促排卵情况、胚胎实验室相关指标及妊娠结局。结果 ≤35岁组和>35岁组中两亚组间的不孕年限、体质量指数(BMI)、基础性激素水平、不孕类型等一般资料比较均无显著性差异(P>0.05)。≤35岁组及>35岁组中拮抗剂组的Gn天数、Gn用量显著低于同组中长方案组(P<0.05),HCG日LH水平显著高于同组中长方案组(P<0.05)。≤35岁组中拮抗剂组的获卵数、MⅡ卵数显著低于长方案组(P<0.05),优质胚胎数、冷冻胚胎数、可利用胚胎率及优质胚胎率均显著高于长方案组(P<0.05);>35岁组中拮抗剂组的获卵数、MⅡ卵数显著低于长方案组(P<0.05),冷冻胚胎数、可利用胚胎率及优质胚胎率显著高于长方案组(P<0.05)。≤35岁组中拮抗剂组的鲜胚移植妊娠率显著高于长方案组(P<0.05);≤35岁组和>35岁组中两亚组间鲜胚移植活产率、单个取卵周期累积活产率、累积流产率等比较均无显著性差异(P>0.05)。结论 对于≤35岁卵巢型EMS合并DOR的不孕患者,拮抗剂方案及长方案各有特点,临床上可根据患者具体情况选择合适的促排卵方案;对于>35岁卵巢型EMS合并DOR的不孕患者,尽管拮抗剂方案和长方案的累积活产率相似,但累积流产率均较高,因此建议这类人群尽早行ART助孕治疗。Objective:To compare the cumulative live birth rates of patients with diminished ovarian reserve(DOR)and endometriosis(EMS)between GnRH antagonist regimen and GnRH agonist regimen.Methods:The clinical data of 218 ovarian EMS patients with DOR undergoing IVF/ICSI-ET in Reproductive Center,Department of Obstetric and Gynecology,the 980 th Hospital of PLA Joint Logistics Support Forces from June 2022 to June 2023 were retrospectively analyzed.A total of 218 oocyte retrieval cycles were included.The patients were divided into two groups as≤35 years old group(139 cycles)and>35 years old group(79 cycles).Then each group was further divided into subgroups as the antagonist group and GnRH-a group based on controlled ovarian hyperstimulation(COH)regimen.The demographic characteristics,COH duration,laboratory indicators related to embryo,and pregnancy outcomes were compared among these groups.Results:There were no significant differences in infertility years,body mass index(BMI),basic sex hormone levels and infertility types between two subgroups of both≤35 years old group and>35 years old group(P>0.05).The duration and dosage of gonadotropin(Gn)use in the antagonist regimen were significantly lower(P<0.05)and the level of luteinizing hormone on HCG day was significantly higher than those in the GnRH-a group(P<0.05).In≤35 years old group,the number of oocytes retrieved and MⅡoocytes in the antagonist group was significantly lower than that in GnRH-a group(P<0.05),and the number of high-quality embryos and frozen embryos,the available embryo and high-quality embryo rates were significantly higher than that in GnRH-a group(P<0.05).In>35 years old group,the number of oocytes retrieved and MⅡoocytes in the antagonist group was significantly lower than that in GnRH-a group(P<0.05),and the number of frozen embryos,the rates of available embryos and high-quality embryos were significantly higher than those in GnRH-a group(P<0.05).In≤35 years old group,the pregnancy rate of fresh transplantation in the antagonist group

关 键 词：子宫内膜异位症 卵巢储备功能减退 拮抗剂方案 累积活产率 

分 类 号：R711.6[医药卫生—妇产科学]