增加hCG扳机剂量在卵巢低反应患者中的应用

doi:10.12280/gjszjk.20210275

摘要/Abstract

摘要：

目的: 探讨增加人绒毛膜促性腺激素（human chorionic gonadotrophin,hCG）扳机剂量对体外受精/卵细胞质内单精子注射-胚胎移植（in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET）周期中低反应患者促性腺激素释放激素激动剂（gonadotropin releasing hormone agonist,GnRHa）长方案鲜胚移植周期临床结局的影响。方法: 回顾性分析2018年1月—2021年3月在我院生殖医学科拟行IVF/ICSI使用GnRHa长方案助孕周期中409例卵巢低反应患者的临床资料。根据hCG日扳机剂量分为2组,常规剂量组（n=337）采用常规艾泽6 500 U扳机,增加剂量组（n=72）采用hCG10 000 U或hCG 2 000 U联合艾泽6 500 U扳机。比较2组患者的获卵数、获卵率,MⅡ率、2PN率、可移植胚胎数、优质胚胎数、临床妊娠率、胚胎植入率、流产率和卵巢过度刺激综合征（OHSS）发生率。结果: 2组获卵数、获卵率、MⅡ率、2PN率、可移植胚胎数、优质胚胎数和流产率比较,差异均无统计学意义（P>0.05）。增加剂量组的临床妊娠率（55.56% vs. 42.73%,P=0.047）和胚胎植入率（50.51% vs. 37.88%,P=0.021）高于常规剂量组。2组均未发生OHSS。结论: 增加hCG扳机剂量可提高卵巢低反应患者GnRHa长方案新鲜周期移植的胚胎植入率和临床妊娠率,相对安全可行,是一种值得推荐的扳机方案。

关键词: 促性腺素释放激素, 绒毛膜促性腺激素, 体外受精, 胚胎移植, 卵巢

Abstract:

Objective: To investigate whether increasing the trigger dose of human chorionic gonadotrophin (hCG) can improve the clinical outcome in patients with poor ovarian response who used gonadotropin releasing hormone agonist (GnRHa) long protocol in in vitro fertilization / intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycle. Methods: The clinical data of 409 patients with poor ovarian response were analyzed retrospectively in our reproductive medicine center from January 2018 to March 2021. According to the trigger dose of hCG, 409 patients were divided into two groups. The conventional dosage group used 6 500 U hCG for trigger (n=337), and the increased dose group (n=72) used hCG 10 000 U or hCG 2 000 U combined with the hCG 6 500 U for trigger. The number of oocytes, the rate of oocyte retrieval, MⅡ rate, 2PN rate, the number of transplantable embryos, the rumber of high-quality embryos, the clinical pregnancy rate, embryo implantation rate, abortion rate and OHSS incidence were compared between the two groups. Results: There were no significant differences in the number of oocytes, the rate of oocyte retrieval, MⅡ rate, 2PN rate, the number of transplantable embryos, the number of high-quality embryos and the rate of abortion between the two groups (all P>0.05). The clinical pregnancy rate (55.56% vs. 42.73%,P=0.047) and the embryo implantation rate（50.51% vs. 37.88%,P=0.021）of the increased dose group was significantly higher than those of the conventional dose group. OHSS was not found in both groups. Conclusions: For the poor ovarian response population, increasing the dose of hCG for trigger can increase embryo implantation rate and the clinical pregnancy rate of fresh cycle transplantation using GnRHa long protocol, which is relatively safe and feasible. This is a recommendable scheme for trigger.

Key words: Gonadotropin-releasing hormone, Chorionic gonadotropin, Fertilization in vitro, Embryo transfer, Ovary

宋昀杰, 张园, 夏心如, 夏梦, 吴畏, 黄洁, 刁飞扬, 冒韵东, 刘嘉茵, 张汝阳, 马翔. 增加hCG扳机剂量在卵巢低反应患者中的应用[J]. 国际生殖健康/计划生育, 2021, 40(6): 441-445.

SONG Yun-jie, ZHANG Yuan, XIA Xin-ru, XIA Meng, WU Wei, HUANG Jie, DIAO Fei-yang, MAO Yun-dong, LIU Jia-yin, ZHANG Ru-yang, MA Xiang. Application of Increasing hCG Trigger Dose in Patients with Poor Ovarian Response[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(6): 441-445.

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参考文献 19

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组别	n	IVF（n）	ICSI（n）	女方年龄（岁）	不孕时间（年）	BMI（kg/m²）	AFC（个）	bFSH（U/L）	AMH（ng/mL）
常规剂量组	337	275	62	32.50±4.45	2.00（1.00,4.00）	22.04±2.78	7.49±3.53	8.78（6.79,11.13）	0.84±0.28
增加剂量组	72	59	13	32.31±4.03	2.00（1.00,4.00）	22.15±3.00	6.38±2.97	9.10（6.44,11.34）	0.84±0.27
t或z				0.370	0.690	-0.300	2.810	0.003	0.210
P				0.714	0.406	0.768	0.006	0.958	0.830

组别	n	IVF（n）	ICSI（n）	女方年龄（岁）	不孕时间（年）	BMI（kg/m²）	AFC（个）	bFSH（U/L）	AMH（ng/mL）
常规剂量组	337	275	62	32.50±4.45	2.00（1.00,4.00）	22.04±2.78	7.49±3.53	8.78（6.79,11.13）	0.84±0.28
增加剂量组	72	59	13	32.31±4.03	2.00（1.00,4.00）	22.15±3.00	6.38±2.97	9.10（6.44,11.34）	0.84±0.27
t或z				0.370	0.690	-0.300	2.810	0.003	0.210
P				0.714	0.406	0.768	0.006	0.958	0.830

组别	n	促排卵方案		Gn启动剂量（U）	Gn使用总天数（d）	扳机日E₂ （pmol/L）	扳机日LH （U/L）	扳机日孕激素（nmol/L）	扳机日≥16 mm 卵泡数（个）	卵泡输出率（%）
组别	n	短效长方案	早卵泡期长方案	Gn启动剂量（U）	Gn使用总天数（d）	扳机日E₂ （pmol/L）	扳机日LH （U/L）	扳机日孕激素（nmol/L）	扳机日≥16 mm 卵泡数（个）	卵泡输出率（%）
常规剂量组	337	135（40.06）	202（59.94）	242.03±52.33	11.31±2.29	4 403.90（2742.70,6 492.20）	1.09（0.66,1.97）	2.74（1.92,3.99）	3.14±1.41	0.40（0.29,0.60）
增加剂量组	72	30（42.22）	42（57.78）	248.61±42.97	11.42±2.57	3 690.20（2 658.68,5 359.40）	1.06 （0.75,1.59）	2.83（1.90,3.67）	3.04±1.34	0.47（0.33,0.70）
t或χ²或z		0.01		-1.13	0.31	3.14	0.17	0.37	0.58	2.35
P		0.905		0.259	0.756	0.077	0.682	0.542	0.565	0.125

组别	n	促排卵方案		Gn启动剂量（U）	Gn使用总天数（d）	扳机日E₂ （pmol/L）	扳机日LH （U/L）	扳机日孕激素（nmol/L）	扳机日≥16 mm 卵泡数（个）	卵泡输出率（%）
组别	n	短效长方案	早卵泡期长方案	Gn启动剂量（U）	Gn使用总天数（d）	扳机日E₂ （pmol/L）	扳机日LH （U/L）	扳机日孕激素（nmol/L）	扳机日≥16 mm 卵泡数（个）	卵泡输出率（%）
常规剂量组	337	135（40.06）	202（59.94）	242.03±52.33	11.31±2.29	4 403.90（2742.70,6 492.20）	1.09（0.66,1.97）	2.74（1.92,3.99）	3.14±1.41	0.40（0.29,0.60）
增加剂量组	72	30（42.22）	42（57.78）	248.61±42.97	11.42±2.57	3 690.20（2 658.68,5 359.40）	1.06 （0.75,1.59）	2.83（1.90,3.67）	3.04±1.34	0.47（0.33,0.70）
t或χ²或z		0.01		-1.13	0.31	3.14	0.17	0.37	0.58	2.35
P		0.905		0.259	0.756	0.077	0.682	0.542	0.565	0.125

组别	n	穿刺卵泡数（个）	获卵数（个）	获卵率（%）	MⅡ率（%）	2PN率（%）	可移植胚胎数（个）	优质胚胎数（个）
常规剂量组	337	4.90±2.18	3.75±1.55	80.67±20.08	96.10±10.75	0.80 （0.60,1.00）	2.55±1.41	1.83±1.39
增加剂量组	72	4.53±1.89	3.60±1.47	84.81±26.86	94.17±10.62	0.83（0.57,1.00）	2.43±1.43	1.72±1.40
t或z		1.46	0.81	-1.24	0.58	0.16	0.62	0.62
P		0.147	0.419	0.219	0.572	0.69	0.535	0.539