改良灵活拮抗剂方案对卵巢功能正常女性COH结局的影响  

Effect of Modified Flexible Antagonist Protocol on the Outcome of COH in Patients with Normal Ovarian Function

作　　者：王冬雪 包莉莉 刘珊 杨波 WANG Dong-xue;BAO Li-li;LIU Shan;YANG Bo(Reproductive Medicine Center,Department of Obstetric and Gynecology,the 980th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China)

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：《国际生殖健康/计划生育杂志》2024年第3期185-189,共5页Journal of International Reproductive Health/Family Planning

摘　　要：目的:分析改良灵活促性腺激素释放激素拮抗剂(gonadotropin releasing hormone antagonist,GnRH-ant)方案对卵巢功能正常女性体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)妊娠结局的影响。方法:回顾性分析2020年1—12月卵巢功能正常的不孕患者行IVF/ICSI-ET助孕的124个周期的临床资料,根据扳机日黄体生成素(luteinizing hormone,LH)<5 U/L时是否添加GnRH-ant,分为改良灵活GnRH-ant组(改良组)和固定GnRH-ant组(固定组),每组均62个周期,比较2组的基线资料、控制性超促排卵(controlled ovarian hyperstimulation,COH)相关指标及妊娠结局。结果:2组患者年龄、窦卵泡计数、体质量指数、不孕年限、基础卵泡刺激素、基础LH、基础雌二醇(estradiol,E_(2))、基础孕酮及抗米勒管激素水平比较差异均无统计学意义(均P>0.05)。改良组促性腺激素(gonadotropin,Gn)用量、Gn天数、GnRH-ant天数及GnRH-ant总量均低于固定组(均P<0.05);2组扳机日子宫内膜厚度比较差异无统计学意义(P>0.05)。添加GnRH-ant日改良组的LH水平高于固定组(P<0.05);2组添加GnRH-ant日E_(2)及孕酮水平、扳机日LH、E_(2)及孕酮水平比较差异均无统计学意义(均P>0.05)。2组卵泡穿刺数、获卵数、MⅡ卵数、双原核(2PN)受精数、可利用胚胎数、优质胚胎数、移植胚胎数、获卵率、MⅡ卵率、2PN受精率、2PN卵裂率及优质胚胎率比较,差异均无统计学意义(均P>0.05);2组无卵泡早排及卵巢过度刺激综合征发生。2组种植率、临床妊娠率、生化妊娠率、流产率及异位妊娠率比较差异无统计学意义(均P>0.05)。结论:两种GnRH-ant方案的临床结局无显著差异,在卫生经济方面改良灵活GnRH-ant方案具有明显的优越性,是卵巢储备功能正常的年轻患者较理想的COH方案。Objective:To analyze the effect of modified flexible genadotropin releasing hormone antagonist(GnRH-ant)protocol on the pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)in patients with normal ovarian function.Methods:The retrospective analysis was performed on 124 IVF/ICSI-ET cycles in infertile patients with normal ovarian function from January to December 2020.According to whether GnRH-ant was added when LH<5 U/L on the trigger day,the cycles were divided into the modified flexible GnRH-ant group(modified group)and the fixed GnRH-ant group(fixed group),with 62 cycles in each group.The basic data,controlled ovarian hyperstimulation(COH)-related indicators and pregnancy outcomes of the two groups were compared.Results:There were no statistically significant differences in age,antral follide count,BMI,infertile duration and basal sexual hormone levels between the two groups(P>0.05).The gonadotropin(Gn)dosage,Gn days,GnRH-ant days and GnRH-ant total amount in the modified group were lower than those in the fixed group(all P<0.05).There was no significant difference in the endometrial thickness on the trigger day between the two groups(P>0.05).The LH level on the GnRH-ant day in the modified group was higher than that in the fixed group(P<0.05).There were no significant differences in E_(2)and progesterone levels on the GnRH-ant day,and LH,E_(2)and progesterone levels on the trigger day between the two groups(all P>0.05).There were no significant differences in the number of follicle puncture,oocytes obtained,MⅡoocytes,2PN fertilization,available embryos,good-quality embryos,transferred embryos,oocyte retrieval rate,MⅡoocyte rate,2PN fertilization rate,2PN cleavage rate,and high-quality embryo rate between the two groups(all P>0.05).No early ovulation of follicles or OHSS was found in the two groups of antagonist protocols.There were no statistically significant differences in the implantation rate,clinical pregnancy rate,biochemical pregnancy rate,abortio

关 键 词：改良灵活GnRH-ant方案 促性腺素释放激素 卵巢储备功能 种植率 妊娠率 

分 类 号：R714.8[医药卫生—妇产科学]