半剂量拮抗剂对IVF/ICSI助孕结局的影响  

Effect of Half-Dose Antagonist on Pregnancy Outcomes of IVF/ICSI

作　　者：陆珏耘 李欣[1] 季慧[1] 赵纯[1] 张军强[1] 凌秀凤[1] LU Jue-yun;LI Xin;JI Hui;ZHAO Chun;ZHANG Jun-qiang;LING Xiu-feng(Women′s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院,南京市妇幼保健院,210004

出　　处：《国际生殖健康/计划生育杂志》2025年第2期110-115,共6页Journal of International Reproductive Health/Family Planning

摘　　要：目的:探讨半剂量促性腺激素释放激素拮抗剂(gonadotropin-releasing hormone antagonist,GnRH-A)对体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)的促排卵结局及临床妊娠结局的影响。方法:回顾性分析2016年1月—2023年4月在南京市妇幼保健院生殖医学中心采用拮抗剂方案促排卵后行IVF/ICSI的6211例患者资料。根据患者每日拮抗剂剂量分为半剂量组(0.125 mg/d,1796例)和常规剂量组(0.25 mg/d,4415例)。以每日拮抗剂使用剂量为因变量计算倾向评分,使2组达到均衡,控制组间的潜在混杂因素,匹配后2组各1796例。比较2组患者的一般情况、临床资料、胚胎实验室结果、鲜胚移植周期临床结局指标。结果:匹配后2组黄体生成素(luteinizing hormone,LH)早发峰发生率、鲜胚移植的临床妊娠结局差异均无统计学意义(P>0.05),半剂量组的拮抗剂使用总剂量和总天数显著低于常规剂量组(P<0.001)。而促排卵结局方面,半剂量组的D3卵裂期胚胎质量低于常规剂量组(P<0.05),D5高评分囊胚率差异无统计学意义(P>0.05)。结论:在拮抗剂方案中,使用半剂量拮抗剂,抑制LH早发峰的效果与常规剂量相当,并且减少了拮抗剂的刺激强度和时长,半剂量GnRH-A方案降低D3卵裂期胚胎的质量,但鲜胚移植周期的妊娠结局可能与常规剂量GnRH-A方案没有显著差异,有待于继续研究。Obejective:To investigate the effect of the half-dose gonadotropin-releasing hormone antagonist(GnRH-A)on the clinical pregnancy outcomes of in vitro fertilization/intracytopiasmic sperm injection(IVF/ICSI).Methods:From January 2016 to April 2023,the clinical data of 6211 patients who underwent IVF/ICSI in the Reproductive Medicine Center of Nanjing Maternity and Child Health Care Hospital were retrospectively analyzed.The patients were divided into the half-dose group(0.125 mg/d,1796 cases)and the conventional-dose group(0.25 mg/d,4415 cases),according to the daily dose of GnRH-A.Propensity scores were calculated using the daily dose of antagonist as the dependent variable to balance the two groups and control the potential confounding factors between the two groups.After matching,1796 cases were in each group.The general condition,clinical data,embryo laboratory results,and clinical outcomes of fresh embryo transfer cycle were compared between the two groups.Results:There were no significant differences in the incidence of early luteinizing hormone(LH)peak,clinical pregnancy outcomes of fresh embryo transfer between the two groups aftermatching(P>0.05).The total dose and total days of antagonist used in the half-dose group were significantly lower than those in the conventional-dose group(P<0.001).However,the quality of D3 cleavage stage embryos in the half-dose group was lower than that in the conventionaldose group(P<0.05),and there was no significant difference in the rate of D5 high-score blastocysts between the two groups(P>0.05).Conclusions:In the GnRH-A regimen,the half-dose GnRH-A has the same effect on the suppression of the early LH surge as the conventional dose,and reduces the stimulation intensity and duration of GnRH-A.Further research is need to testify whether the half-dose GnRH-A regimen gets the similar pregnancy outcome of fresh embryo transfer cycles,although the half-dose GnRH-A reduces the quality of D3 cleavage stage embryos when compared with the conventional-dose GnRH-A regimen.

关 键 词：促性腺激素释放激素拮抗剂 半剂量 体外受精 精子注射 细胞质内 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]