不同促性腺激素进行控制性超促排卵的临床结局比较

Comparison of clinical outcomes of controlled ovarian stimulation with different gonadotropin

目的探讨不同促性腺激素(Gn)[重组人促卵泡激素(rFSH)与尿源性卵泡刺激素(uFSH)]进行控制性超促排卵(COH)临床结局的差异。方法选择2011年1月至2013年12月于扬州大学临床医学院生殖医学中心进行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕的396例患者共计428个周期为研究对象。按使用Gn药物的不同,将其分为rFSH组(253个周期)和uFSH组(175个周期)。比较两组患者一般情况、Gn用量、Gn使用天数、获卵数、优质卵泡数、种植率、不良结局发生率、妊娠率、活产率、自然流产率、多胎妊娠率以及卵巢刺激综合征(OHSS)发生率。两组患者年龄、体质指数(BMI)及不孕年限等一般临床病历资料比较,差异均无统计学意义(P>0.05)。结果 1两组患者不孕因素中男方因素比较,差异有统计学意义(χ2=10.322;P<0.05)。而两组患者年龄、BMI、不孕年限、不孕类型、不孕原因中子宫内膜异位症、多囊卵巢综合征(PCOS)、不明原因不孕等方面比较,差异均无统计学意义(P>0.05)。2rFSH组和uFSH组Gn使用天数[(9.4±1.7)d vs(9.8±2.2)d]、Gn用量[(1 883.5±532.3)U vs(2 277.1±694.2)U]、获卵数[(12.3±6.1)个vs(10.1±5.4)个]、优质卵泡数[(9.1±5.2)个vs(7.8±4.9)个]、不良周期结局(9.1%vs 25.1%)、注射hCG日孕酮水平[(3.7±2.1)U/L vs(2.8±1.6)U/L]、活产率(69.7%vs 50.0%)比较,差异均有统计学意义(χ2=2.154,6.227,3.564,2.373,20.187,3.488,0.033;P<0.05)。结论 rFSH所需Gn总剂量少,刺激周期短,改善了卵母细胞的数量和质量,并能减少不良结局发生率,最终获得更高的活产率。

Objective To investigate differences in clinical outcomes of ovulation by different gonadotropin （Gn）, including recombinant human follicle stimulating hormone （rFSH） and urinary FSH （uFSH）. Methods A total of 396 cases of patients undergoing in vitro fertilization/intra-cytoplasmic sperm injection and embryo transfer （IVF/ICSPET）in Reproductive Medicine Center of Clinical Medical School of Yangzhou University from January 2011 to December 2013, a total of 428 cycles were collected as the research object. According to different types of Gn, the patient were divided into rFSH group （253 cycles） and uFSH group （175 cycles）. General data, Gn dosage, number of Gn days, number of oocytes, the number of high-quality eggs, implantation rate, the incidence of adverse outcomes, pregnancy, live birth rate, abortion rate, multiple pregnancies and the incidence of ovarian hyperstimulation syndrome（OHSS） between two groups were compared. There were no significant differences in age, body mass index （BMI）, and other clinical data between two groups （P〉0.05）. Results ①The comparison between two groups of patients infertility factors, the difference of male factor was statistically significant（x^2 = 10. 322, P〈0.05）. There were no statistically significant difference between two groups in age, BMI, duration of infertility, infertility type, causes of infertility in endometriosis, polycystic ovary syndrome （PCOS）, unexplained infertility, etc. （P〉0.05）. ②The difference in number of Gn days F（9.4±1.7） d vs （9.8±2.2） d], Gn dosage [（1 883.5±532.3） U vs （2 277.1±694.2） U], the number of oocytes [（12.3±6.1） vs （10. 14± 5.4）], the number of high-quality eggs [（9.14±5. 2） vs （7.8±4.9）], the incidence of adverse outcomes （9.1% vs 25.1%）, progesterone level of hCG day [（3.74±2.1） U / L vs （2.84±1.6） U / L], live birth rate （69.7% vs 50. 0%） between two groups were statistically significant （X^2 = 2. 154, 6. 227, 3. 564, 2. 373, 20. 187, 3. 488, 0. 033; P（O. 05）. Conclusions Using rFSH, the total dose of Gn is less required and period to stimulate is short, it also improvs the quantity and quality of ooeytes, at the same time, it can reduce the rate of adverse outcomes, and get high live birth rate.