PPOS方案与拮抗剂方案对卵巢高储备者胚胎整倍体率的影响  

Effects of PPOS Scheme and Antagonist Protocol Scheme on the Embryo Euploid Rates in Patients With High Ovarian Reserve

作　　者：成海英 黄向红 谭小军 罗辰 雷茜 贺艳坤 CHENG Haiying;HUANG Xianghong;TAN Xiaojun;LUO Chen;LEI Xi;HE Yankun(Reproductive and Genetic Center,Xiangtan Central Hospital,Xiangtan Hunan 411100,China)

机构地区：[1]湘潭市中心医院生殖与遗传中心,湖南湘潭411100

出　　处：《中国卫生标准管理》2025年第2期13-16,130,共5页China Health Standard Management

摘　　要：目的探讨行胚胎植入前非整倍体遗传学检测(preimplantation genetic testing,PGT-A)的卵巢高储备患者,高孕激素状态下促排卵(progestin-primed ovarian stimulation,PPOS)方案和促性腺激素释放激素(gonadotropin-releasing hormone,Gn RH)拮抗剂方案对其胚胎整倍体率的影响。方法回顾性分析2017年1月—2022年12月在湘潭市中心医院行PGT-A的169例卵巢高储备患者。根据促排方案分为PPOS组78例和拮抗剂组91例。比较2组患者的促排卵效果及PGT-A检测结果。结果2组患者的促性腺激素(gonadotropin,Gn)使用天数、Gn总量、轻中度卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)、重度OHSS、MⅡ卵囊胚形成率、整倍体囊胚率、首个冻胚移植周期临床妊娠率、早期流产率及活产率比较,差异均无统计学意义(P>0.05)。而PPOS组的获卵数、MⅡ卵数、卵泡输出率分别为(12.64±3.20)个、(12.55±3.12)个、(89.27±23.11)%,低于拮抗剂组的(14.19±3.80)个、(14.33±3.25)个、(102.41±29.23)%,差异有统计学意义(P<0.05)。PPOS组无患者出现早发黄体生成素(luteinizing hormone,LH)峰,而拮抗剂组有2例患者出现早发LH峰,差异无统计学意义(P>0.05)。结论对于行PGT-A的卵巢高储备患者,应用PPOS方案和拮抗剂方案均能较有效地抑制早发LH水平峰、避免重度OHSS发生以及获得较好的整倍体囊胚率。Objective To exploring the effects of using progestinprimed ovarian stimulation(PPOS)and gonadotropin-releasing hormone(GnRH)antagonist protocol on embryonic euploidy rates in high ovarian reserve patients undergoing preimplantation genetic testing(PGT-A).Methods A total of 169 patients with high ovarian reserve who received PGT-A in Xiangtan Central Hospital from January 2017 to December 2022 were retrospectively analyzed.According to the ovulation-induction protocol,78 patients were included in the PPOS group and 91 patients in the antagonist group.The ovulation promoting effect and PGT-A test results of 2 groups were compared.Results There were no significant differences in gonadotropin(Gn)use days,total amount of Gn,mild to moderate ovarian hyperstimulation syndrome(OHSS),severe OHSS,ooblastocyst formation rate of MⅡ,euploid blastocyst rate,clinical pregnancy rate in the first frozen embryo transfer cycle,early abortion rate and live birth rate between 2 groups(P>0.05).The number of eggs obtained,the number of eggs in MⅡand the follicle output rate in PPOS group were(12.64±3.20),(12.55±3.12),(89.27±23.11)%,which were lower than(14.19±3.80),(14.33±3.25),(102.41±29.23)%in antagonist group,and the differences were statistically significant(P<0.05).No patient in the PPOS group showed an early onset luteinizing hormone(LH)peak,while two patients in the antagonist group showed early onset LH peak,and the difference was no significant(P>0.05).Conclusion For ovarian high reserve patients undergoing PGT-A,both the PPOS protocol and antagonist protocol can effectively inhibit premature LH surge,avoid severe OHSS,and achieve a better rate of diploid blastocysts.

关 键 词：胚胎植入前非整倍体遗传学检测 高孕激素状态下促排卵 拮抗剂方案 整倍体胚胎 卵巢高储备 早发黄体生成素峰 

分 类 号：R715[医药卫生—妇产科学]