改良灵活拮抗剂方案对卵巢功能正常女性COH结局的影响

doi:10.12280/gjszjk.20240023

摘要/Abstract

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，E₂）、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E₂及孕酮水平、扳机日LH、E₂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。

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

Abstract:

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 E₂ and progesterone levels on the GnRH-ant day, and LH, E₂ 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, MⅡ oocytes, 2PN fertilization, available embryos, good-quality embryos, transferred embryos, oocyte retrieval rate, MⅡ oocyte 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, abortion rate, and ectopic pregnancy rate between the two groups (all P>0.05). Conclusions: There were no significant differences in the clinical outcomes between the two groups of antagonist protocols. In terms of health and economy, the modified flexible GnRH-ant has obvious advantages, which is an ideal ovulation induction protocol for those patients with normal ovarian reserve.

Key words: Modified flexible gonadotropin releasing hormone antagonist protocol, Gonadotropin-releasing hormone, Ovarian reserve, Implantation rate, Pregnancy rate

王冬雪, 包莉莉, 刘珊, 杨波. 改良灵活拮抗剂方案对卵巢功能正常女性COH结局的影响[J]. 国际生殖健康/计划生育杂志, 2024, 43(3): 185-189.

WANG Dong-xue, BAO Li-li, LIU Shan, YANG Bo. Effect of Modified Flexible Antagonist Protocol on the Outcome of COH in Patients with Normal Ovarian Function[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(3): 185-189.

图/表 5

参考文献 21

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组别	n	年龄（岁）	AFC （个）	BMI （kg/m²）	不孕年限（年）	基础FSH （U/L）	基础LH （U/L）	基础E₂ （pg/mL）	基础孕酮（ng/mL）	AMH （ng/mL）
改良组	62	31.00±2.51	11.39±3.70	22.21±2.65	3.00（2.00，5.00）	6.25±1.67	3.88±1.45	46.21±26.85	0.48（0.39，0.62）	2.73±0.93
固定组	62	31.16±2.63	12.65±4.02	22.16±2.15	3.00（2.00，4.75）	6.32±1.68	4.12±1.60	48.47±15.36	0.42（0.27，0.70）	2.64±0.89
t或Z		0.349	1.811	-0.120	-0.816	0.236	0.888	0.576	-1.250	-0.554
P		0.727	0.073	0.904	0.414	0.814	0.377	0.566	0.211	0.581

组别	n	年龄（岁）	AFC （个）	BMI （kg/m²）	不孕年限（年）	基础FSH （U/L）	基础LH （U/L）	基础E₂ （pg/mL）	基础孕酮（ng/mL）	AMH （ng/mL）
改良组	62	31.00±2.51	11.39±3.70	22.21±2.65	3.00（2.00，5.00）	6.25±1.67	3.88±1.45	46.21±26.85	0.48（0.39，0.62）	2.73±0.93
固定组	62	31.16±2.63	12.65±4.02	22.16±2.15	3.00（2.00，4.75）	6.32±1.68	4.12±1.60	48.47±15.36	0.42（0.27，0.70）	2.64±0.89
t或Z		0.349	1.811	-0.120	-0.816	0.236	0.888	0.576	-1.250	-0.554
P		0.727	0.073	0.904	0.414	0.814	0.377	0.566	0.211	0.581

组别	n	Gn用量（U）	Gn天数（d）	GnRH-ant天数（d）	GnRH-ant总量（mg）	扳机日子宫内膜厚度（mm）
改良组	62	2 098.71±318.40	9.81±1.04	2.74±0.94	0.75（0.50，1.00）	10.77±1.67
固定组	62	2 228.47±398.99	10.26±1.33	4.52±0.84	1.00（1.00，1.25）	10.56±1.73
t或Z		2.002	2.108	11.058	-8.147	0.676
P		0.048	0.037	0.000	0.000	0.500

组别	n	Gn用量（U）	Gn天数（d）	GnRH-ant天数（d）	GnRH-ant总量（mg）	扳机日子宫内膜厚度（mm）
改良组	62	2 098.71±318.40	9.81±1.04	2.74±0.94	0.75（0.50，1.00）	10.77±1.67
固定组	62	2 228.47±398.99	10.26±1.33	4.52±0.84	1.00（1.00，1.25）	10.56±1.73
t或Z		2.002	2.108	11.058	-8.147	0.676
P		0.048	0.037	0.000	0.000	0.500

组别	n	添加GnRH-ant日			扳机日
组别	n	LH（U/L）	E₂（pg/mL）	孕酮（ng/mL）	LH（U/L）	E₂（pg/mL）	孕酮（ng/mL）
改良组	62	5.02（3.40，6.42）	1 015.50（840.50，1 176.00）	0.43±0.19	1.53（1.07，3.00）	3 006.00（2 519.00，4 190.75）	0.81±0.32
固定组	62	3.09（2.02，5.14）	1 070.50（712.00，1 231.75）	0.42±0.16	1.95（1.48，2.81）	2 840.00（1 700.50，4 365.50）	0.82±0.28
t或Z		-4.508	-0.157	0.217	-1.724	-1.918	0.081
P		0.000	0.875	0.828	0.085	0.055	0.936