波塞冬标准年轻预期低预后患者卵泡期长效长方案不同促性腺激素启动剂量的临床及围产结局比较  

Comparison of clinical and perinatal outcomes of different gonadotropin starting dosages in the early-follicular phase long-acting GnRH agonist long protocol in young patients with expected poor prognosis according to POSEIDON criteria

作　　者：邹海蛟 王芳[1] 史昊 焦芸云 马源[1] 刘宇[1] 郭艺红[1] Zou Haijiao;Wang Fang;Shi Hao;Jiao Yunyun;Ma Yuan;Liu Yu;Guo Yihong(Center of Reproductive Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院生殖医学中心,郑州450052

出　　处：《中华生殖与避孕杂志》2024年第11期1121-1130,共10页Chinese Journal of Reproduction and Contraception

基　　金：中原英才计划(育才系列)-中原医疗卫生领军人才(中原名医)。

摘　　要：目的探讨符合波塞冬诊断标准年轻预期低预后患者卵泡期长效长方案不同促性腺激素(gonadotropin,Gn)启动剂量的临床结局及围产结局是否存在差异。方法本研究为回顾性队列研究,分析了2016年1月1日至2022年6月30日于郑州大学第一附属医院生殖医学中心首次行新鲜周期体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)-胚胎移植(embryo transfer,ET)患者的临床资料,筛选促排卵方案为卵泡期长效长方案且符合年轻预期低预后患者诊断标准的首个周期纳入研究。按照卵巢刺激周期的Gn启动剂量将患者分为低剂量组(Gn<225 U)、中剂量组(225 U≤Gn<300 U)和高剂量组(Gn=300 U),分别比较各组间患者的临床及围产结局。结果本研究共纳入1659个周期,包括Gn启动低剂量组316个周期,中剂量组536个周期,高剂量组807个周期。高剂量组获卵总数[6.00(4.00,9.00)个]小于中剂量组[8.00(6.00,11.00)个]和低剂量组[11.00(7.00,13.00)个],中剂量组小于低剂量组,差异均有统计学意义(均P<0.017)。3组间卵子成熟率、IVF/ICSI正常受精率及优质胚胎率差异均无统计学意义(均P>0.05),囊胚形成率在低剂量组[20.33%(425/2090)]、中剂量组[17.28%(510/2951)]、高剂量组[14.62%(518/3542)]依次降低,组间两两比较差异均有统计学意义(均P<0.017)。不同Gn启动剂量分组患者之间的临床妊娠率、生化妊娠率、异位妊娠率、流产率、流产组织绒毛染色体异常率及早产率差异均无统计学意义(均P>0.05),高剂量组活产率[47.83%(386/807)]显著低于低剂量组[57.28%(181/316),P=0.004]。多因素logistic回归调整混杂因素后,高剂量的Gn启动剂量是活产率下降的独立危险因素(aOR=0.659,95%CI:0.462~0.941,P=0.022)。无论是否调整混杂因素,各组间围产结局差异均无统计学意义(均P>0.05)。结论对于行首次卵泡期长效长方案促排卵的年轻预期低预后患�Objective:To investigate whether there are differences in clinical outcomes and perinatal outcomes associated with different initial dosages of gonadotropin(Gn)in expected poor prognosis young patients,diagnosed according to the POSEIDON criteria,undergoing the early-follicular phase long-acting gonadotropin-releasing hormone agonist(GnRH-a)long protocol.Methods:This retrospective cohort study analyzed clinical data from patients who underwent their first in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)-fresh embryo transfer(ET)cycle at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University between January 1,2016,and June 30,2022.Patients included in the study were those who underwent ovarian stimulation with the early-follicular phase long-acting GnRH-a long protocol and young expected poor prognosis.Patients were divided into three groups based on the starting Gn dosage:low-dose group(Gn<225 U),medium-dose group(225 U≤Gn<300 U),and high-dose group(Gn=300 U).Clinical and perinatal outcomes were compared among the three groups.Results:A total of 1659 cycles were included in the study,with 316 cycles in the low-dose group,536 cycles in the medium-dose group,and 807 cycles in the high-dose group.The number of oocytes retrieved in the high-dose group[6.00(4.00,9.00)]was less than that in the medium-dose group[8.00(6.00,11.00)]and the low-dose group[11.00(7.00,13.00)],which in the medium-dose group was less than that in the low-dose group,and the differences were statistically significant(all P<0.017).There were no significant statistical differences in oocyte maturation rate,normal fertilization rate of IVF/ICSI,or high-quality embryo rate among the three groups(all P>0.05).The blastocyst formation rates decreased sequentially in the low-dose group[20.33%(425/2090)],medium-dose group[17.28%(510/2951)],and high-dose group[14.62%(518/3542)],with significant differences between each pair of groups(all P<0.017).There were no significant differences in clinical pregna

关 键 词：促性腺激素 卵巢低反应 波塞冬标准 卵泡期长效长方案 围产结局 

分 类 号：R714.8[医药卫生—妇产科学]