促性腺激素释放激素拮抗剂方案中卵巢反应性相关因素分析

Relative factors of ovarian response in GnRH-ant protocol

目的研究促性腺激素释放激素拮抗剂(GnRH-ant)方案中卵巢反应性的影响因素及其与妊娠结局的关系。方法分析因输卵管因素和(或)男方因素在我院生殖中心进行体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕的患者共452个周期,按患者的卵巢反应性分为卵巢低反应组、正常反应组和高反应组,比较拮抗剂方案中患者的一般情况、内分泌激素水平、促性腺激素(Gn)用药时间和剂量、获卵数、受精率及临床妊娠结局,并分析上述因素与卵巢反应性的关系。结果(1)在卵巢低反应组、正常反应组和高反应组中,患者的年龄、基础卵泡刺激素(bFSH)水平、基础睾酮(T)水平、窦卵泡计数(AFC)之间差异有统计学意义(P<0.05)。(2)三组患者人绒毛膜促性腺激素(HCG)日的雌二醇(E_2)水平、Gn的用量、取卵数、移植数、冷冻数及流产率之间差异有统计学意义(P<0.05);Gn的用药时间、子宫内膜厚度之间差异无统计学意义(P>0.05);卵巢低反应组的临床妊娠率(30.28%)明显低于其他两组,差异有统计学意义(P<0.05)。(3)多因素Logistic回归显示,年龄、bFSH水平及总Gn用量与卵巢反应性呈负相关,取卵数与卵巢反应性呈正相关。结论拮抗剂方案中,卵巢反应性与患者的年龄、bFSH水平及Gn用量有关,对卵巢反应性进行评估应当结合患者的一般情况、超声学检查及内分泌特点等多因素进行综合分析。

Objective： To study the effective factors of ovarian response and its relationship with pregnancy outcomes in gonadotropin-releasing hormone antagonists（GnRH-ant）protocol. Methods. The women who underwent in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI） therapy due to tubal and/or male factors were included in this study. 452 controlled ovarian stimulation cycles were analyzed. According to ovarian response, all the patients were divided into three groups, the poor ovarian response （POR） group, the normal ovarian response （NOR） group and the high ovarian response （HOR） group. Women＇s general characteristics, basal and HCG day hormone levels, duration of controlled ovarian hyperstimulation （COH） and dosage of ganadotropin （Gn）, retrieved oocytes, fertilization rate, transfer embryos, pregnant outcomes were evaluated in GnRH-ant protocol. The relative factors with ovarian response were analyzed by multi-factor Logistic regression. Results： （1） There were significant differences on age, serum basal follicle-stimulating hormone （bFSH）, serum basal testosterone （T）, antral follicle count （AFC） among the three groups （P〈0.05）.（2） The significant differences were found in levels of estradiol （E2） on HCG day, dosage of Gn, retrieved oocytes, transfer embryos and miscarriage rate （P〈0.05）. There was no significant difference in duration of COH, endometrium thickness among the three groups （P〉0.05）. Compared to the other groups, the clinical pregnancy rate （30. 28%） in POR group was significantly lower （P〈0.05）. （3） Multiple factors Logistic regression analysis demonstrated that age, bFSH levels and dosage of Gn were negatively correlated with ovarian response, and the number of retrieval oocytes was positively related to ovarian response. Conclusions： Ovarian response is associated with the age, bFSH level and dosage of ganadotropins in COH of women who undergo IVF/ICSI with GnRH-ant protocol. It should combine with general characteristics, ultrasonic examination, endocrine features and Gn reactivity to comprehensive evaluate ovarian response in COH.