拮抗剂方案与黄体期长方案在卵巢正常反应患者新鲜胚胎移植中的临床结局比较

Comparison of clinical outcomes between gonadotropin⁃releasing hormone antagonist protocol and luteal phase long protocol in fresh embryo transfer in patients with normal response

目的 比较拮抗剂方案与黄体期长方案应用于卵巢正常反应人群新鲜胚胎移植的临床结局。方法 回顾性分析2017年1月至2021年7月我中心首次行体外受精新鲜胚胎移植的卵巢正常反应患者的病例资料,按超促排卵方案分为拮抗剂方案组(n=115例)和黄体期长方案组(n=398例),比较二组间的一般资料、超促排卵指标及妊娠结局。结果 超促排卵过程中,拮抗剂组促性腺激素(Gn)使用天数、Gn用量均低于黄体期长方案组,但拮抗剂组人绒毛膜促性腺激素(hCG)扳机日卵泡刺激素(FSH)和黄体生成素LH水平均高于黄体期长方案组,差异有统计学意义(P<0.05)。黄体期长方案组获卵数、成熟卵子数、受精率、可利用胚胎数、优质胚胎数均较拮抗剂有升高趋势,但两组间无显著性差异(P>0.05)。在临床结局方面,拮抗剂方案组和长方案组的临床妊娠率和活产率比较(57.4%vs 56%,50%vs45.7%),统计学无显著性差异(P>0.05)。两组间早期流产率和异位妊娠率分别为6%vs 7.5%和1.7%vs 2.8%,差异均无统计学意义(P>0.05)。结论 对于正常反应患者,两组方案的临床妊娠结局相关指标均无显著性差异,但拮抗剂方案显著减少Gn用量及刺激天数,且缩短达活产的时间,选择拮抗剂方案可能获益更高。

Objective To compare the clinical outcomes between gonadotrophin⁃releasing hormone(GnRH)antagonist protocol and luteal phase long protocol in fresh embryo transfer in patients with normal response.Methods From January 2017 to July 2021,the clinical case data of 513 patients with normal ovarian response who underwent the first in vitro fertilization fresh embryo transfer at the Reproductive Medicine Center,People’s Hospital of Qingyuan were analyzed retrospectively.The cases were divided into Gn⁃RH antagonist protocol group(n=115)and luteal phase long protocol group(n=398)according to different ovulation induction protocol,and the basic clinical data,ovulation induction indicators and pregnancy outcomes were compared between the two groups.Results During ovulation induction,the number of days of gonadotropin(Gn)use and the dosage of Gn in the GnRH antagonist protocol group were lower than those in the luteal phase long protocol group,but the levels of HSH and LH on HCG days in the antagonist group were higher than those in the long protocol group,and the differences were statistically significant(P<0.05).The number of retrieved oocytes,the number of mature oocytes,the rate of fertilization,the number of available embryos,and the number of high⁃quality embryos in the long protocol group tended to be higher than that of the antagonist group,but there was no significant difference between the two groups(P>0.05).In terms of clinical outcomes,there was no statistically significant difference(P>0.05)in the clinical pregnancy and live birth rates between the antagonist group and the long protocol group(57.4%vs 56%,50%vs 45.7%).The rates of early miscarriage and ectopic pregnancy were between the two groups were 6%vs 7.5%and 1.7%vs 2.8%,respectively,with no statistically significant difference(P>0.05).Conclusions For patients with normal response,there were no significant differences in clinical pregnancy outcome⁃related indicators between the two protocols,but the Gn⁃RH antagonist protocol significantly reduced Gn dose and days of stimulation,and shortened the time to reach live birth,which may be of greater benefit.