不同拮抗剂药物用于拮抗剂灵活方案对IVF/ICSI-ET临床结局的影响

The effect of different antagonists on the clinical outcomes of IVF/ICSI-ET in flexible GnRH antagonist protocol

目的探讨不同的促性腺激素释放激素(GnRH)拮抗剂药物用于拮抗剂灵活方案,对IVF/ICSI-ET助孕临床结局的影响。方法回顾性分析2023年1—12月在我院行拮抗剂灵活方案促排卵IVF/ICSI-ET助孕治疗患者的临床资料。根据拮抗剂方案中所使用药物的不同进行分组:进口加尼瑞克组(A组)、国产西曲瑞克组(B组)及进口西曲瑞克组(C组),利用倾向性评分匹配法(PSM)按照1∶1的比例进行匹配,最终A、B组比较时各纳入405个周期,B、C组比较时各纳入407个周期。分别比较A、B两组和B、C两组的一般资料、促排卵情况及妊娠结局。结果A、B两组的年龄、体质量指数(BMI)、不孕年限、基础性激素水平、基础窦卵泡数(AFC)等一般资料比较均无显著性差异(P>0.05);两组的扳机日激素水平、Gn总量及天数、拮抗剂用量、获卵数、胚胎移植率、卵裂期优胚率、冷冻周期率、早排取消率、中重度卵巢过度刺激综合征(OHSS)发生率比较均无显著性差异(P>0.05);B组的MⅡ卵率(80.75%vs.77.85%)、2PN受精率(71.21%vs.68.73%)、囊胚形成率(53.97%vs.49.04%)显著高于A组(P<0.05);A、B两组各纳入110个鲜胚移植周期进行比较,两组移植周期的一般资料比较无显著性差异(P>0.05),两组的移植胚胎数、移植日内膜厚度及着床率、临床妊娠率、早期流产率、异位妊娠率及多胎率比较均无显著性差异(P>0.05)。B、C两组的一般资料比较均无显著性差异(P>0.05);B组的扳机日E 2、P、LH水平及获卵数[(13.31±7.33)枚vs.(14.57±8.79)枚]显著低于C组(P<0.05),2PN受精率显著高于C组(70.10%vs.66.93%,P<0.05);两组的112个鲜胚移植周期中移植胚胎数、着床率、临床妊娠率、早期流产率及多胎率比较均无显著性差异(P>0.05)。结论国产西曲瑞克用于拮抗剂灵活方案时,可与进口加尼瑞克、进口西曲瑞克获得相似的临床结局。但目前国产西曲瑞克使用时间较短,尚需更多的数据积累提供证据。

Objective:To explore the impact of different gonadotropin-releasing hormone(GnRH)antagonists on the clinical outcomes of IVF/ICSI-ET in a flexible GnRH antagonist protocol.Methods:Data of patients treated for ovarian stimulation using a flexible GnRH antagonist regimen at Sichuan Jinxin Xinan Women’s and Children’s Hospital from January to December 2023 were retrospectively analyzed.According to the different drugs used in the antagonist regimen,the patients were divided into three groups:imported Ganirelix group(group A),domestic Cetrorelix group(group B),and imported Cetrorelix group(group C).The propensity score matching method(PSM)was used to match them in a 1∶1 ratio.Finally,405 cycles were included in group A and B for comparison,and 407 cycles were included in Group B and C for comparison.The basic characteristics,ovulation induction status,and pregnancy outcomes were compared between group A and group B,as well as group B and group C.Results:There were no significant differences in the age,body mass index(BMI),years of infertility,basal hormone levels,and basal follicle count(AFC)between group A and group B(P>0.05).There were no significant differences in terms of hormone levels on trigger day,total amount and duration of gonadotropin(Gn)use,dosage of antagonists,number of retrieved oocytes,embryo transfer rate,rate of high-quality embryos during cleavage stage,frozen cycle rate,rate of early ovulation cancellation,and incidence of moderate to severe ovarian hyperstimulation syndrome(OHSS)between group A and group B(P>0.05).The MⅡoocytes rate(80.75%vs.77.85%),2PN fertilization rate(71.21%vs.68.73%),and blastocyst formation rate(53.97%vs.49.04%)in group B were significantly higher than those in group A(P<0.05).Two groups of A and B were compared with 110 fresh embryo transfer cycles,and there were no significant differences in basic characteristics between the two groups(P>0.05).There were no significant differences in the number of transplanted embryos,endometrial thickness and implantation rate on the day of transplantation,clinical pregnancy rate,early miscarriage rate,ectopic pregnancy rate,and multiple pregnancy rate between the two groups(P>0.05).There were no significant differences in basic characteristics between group B and group C(P>0.05).The levels of E 2,progesterone(P)and LH on trigger day,and the number of retrieved oocytes[(13.31±7.33)vs.(14.57±8.79)]in group B were significantly lower than those in group C(P<0.05),and the 2PN fertilization rate was significantly higher(70.10%vs.66.93%,P<0.05).There were no significant differences in the number of transferred embryos,the implantation rate,clinical pregnancy rate,early miscarriage rate,and multiple pregnancy rate between the two groups regarding 112 fresh embryo transfers(P>0.05).Conclusions:When domestic Cetrorelix is used as a flexible antagonist regimen,it can achieve similar clinical outcomes as imported Ganirelix and imported Cetrorelix.But as of now,the time of domestic Cetrorelix use has been relatively short,and data accumulation is needed for more evidences.