黄体支持中添加GnRH-a/HCG对卵巢储备功能减退患者新鲜周期胚胎移植助孕结局的影响  

Effect of adding human chorionic gonadotropin/gonadotropin releasing hormone agonist to luteal support on the outcome of fresh embryo transfer in patients with diminished ovarian reserve

作　　者：于朝[1] 王聪 方颖[1] 沈帆 杨晓葵[1] Yu Chao;Wang Cong;Fang Ying;Shen Fan;Yang Xiaokui(Department of Human Reproductive Medicine,Beijing Obstetrics and Gynecology Hospital/Beijing Maternal and Child Health Care Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院生殖医学科,100026

出　　处：《北京医学》2025年第2期107-111,共5页Beijing Medical Journal

基　　金：北京市医院管理中心“登峰”人才培养计划(DFL20191401);北京市自然科学基金(7232061)。

摘　　要：目的探讨在黄体支持中添加促性腺激素释放激素激动剂(gonadotropin releasing hormone agonist,GnRH-a)或人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)对于卵巢储备功能减退(diminished ovarian reserve,DOR)患者新鲜周期胚胎移植助孕结局的影响。方法回顾性选取2019—2023年首都医科大学附属北京妇产医院进行体外受精-胚胎移植或卵胞浆内单精子注射治疗的DOR患者268例,根据黄体支持方案分为常规黄体支持组(n=132)、添加HCG黄体支持组(n=84)、添加GnRH-a黄体支持组(n=52),比较3组患者的基础资料、实验室指标、临床妊娠率。结果268例患者年龄21~42岁,平均(36.2±4.6)岁。添加HCG黄体支持组患者移植后第1次HCG及孕酮(progesterone,P)、第2次及第3次P水平、临床妊娠率均高于常规黄体支持组及GnRH-a黄体支持组,差异均有统计学意义(P<0.05)。3组间移植后第2次及第3次HCG、早期流产率、持续妊娠率的比较,差异均无统计学意义(P>0.05)。多因素logistic回归分析结果显示,添加HCG黄体支持(OR=2.554,95%CI:1.407~4.635,P=0.002)、年龄越低(OR=0.901,95%CI:0.848~0.957,P=0.001)的DOR患者新鲜周期胚胎移植后临床妊娠的可能性越大。结论黄体支持中添加HCG能够有效改善DOR患者新鲜周期胚胎移植的临床结局,添加GnRH-a对于改善临床结局无明显效果。Objective To explore the effect of adding gonadotropin releasing hormone agonist(GnRH-a)or human chorionic gonadotropin(HCG)to luteal support on the outcome of fresh cycle embryo transfer in patients with diminished ovarian reserve(DOR).Methods A total of 268 DOR patients who underwent in vitro fertilization and embryo transfer(IVF-ET)or intracytoplasmic sperm injection(ICSI)treatment in the Beijing Obstetrics and Gynecology Hospital Capital Medical University from 2019 to 2023 were selected and were divided into the conventional luteal support group(n=132),the HCG-added luteal support group(n=84),and the GnRH-a added luteal support group(n=52)according to the luteal support protocol.The basic data,laboratory indexes and pregnancy outcomes between the three groups were compared.Results The age of 268 patients ranged from 21 to 42 years,with an average of(36.2±4.6)years.The levels of the first HCG and progesterone(P),second and third P after transplantation and the clinical pregnancy rate in the HCG-added luteal support group were higher than those in the conventional luteal support group and the GnRH-a added luteal support group,and the differences were statistically significant(P<0.05).There was no significant difference in the second and third HCG,early abortion rate and sustained pregnancy rate among the three groups(P>0.05).The results of multivariate logistic regression analysis showed that the patients with DOR who added HCG luteal support(OR=2.554,95%CI:1.407-4.635,P=0.002)and the younger(OR=0.901,95%CI:0.848-0.957,P=0.001),the greater the possibility of clinical pregnancy after fresh embryo transfer.Conclusions Adding HCG to luteal support can effectively improve the clinical outcome of fresh embryo transfer in DOR patients,while adding GnRH-a has no obvious effect on improving the clinical outcome.

关 键 词：卵巢储备功能减退 黄体支持 促性腺激素释放激素激动剂 人绒毛膜促性腺激素 新鲜周期胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学]