长方案添加HMG时机对供精体外受精-胚胎移植结局的影响

Effect of timing of adding HMG in the long protocol on the outcome of IVF-ET with donor sperm

目的比较长方案添加人绝经期促性腺激素(HMG)时机对供精体外受精-胚胎移植(IVF-D)结局的影响。方法回顾性分析2010年1月至2016年1月在本院生殖中心就诊进行IVF-D助孕的371例不育患者资料。所有患者均采取长方案进行控制性促排卵(COH),按照添加HMG时机分为两组:卵泡>14mm时添加HMG为A组(227个周期),与rFSH同时添加HMG为B组(144个周期)。比较两组Gn总量及天数、HCG日E_2和P、获卵数、2PN率、成胚数、优胚率、胚胎着床率、临床妊娠率、流产率和活产率,并以年龄进行亚组分析。结果与B组相比,A组Gn总量和天数、HCG日的孕酮(P)水平以及优胚率均显著性降低,差异有统计学意义(P<0.05);两组间HCG日E_2、获卵数、2PN率、成胚数、胚胎着床率的差异均无统计学意义,A组临床妊娠率和活产率均高于B组,流产率低于B组,但差异无统计学意义;<35岁的患者中,A组比B组的Gn总量和天数少,差异有统计学意义(P<0.05);≥35岁的患者中,B组的优胚率比A组多,差异有统计学意义(P<0.05)。结论长方案促排卵于卵泡晚期添加HMG在不影响妊娠结局的情况下,可以减少Gn用量,降低费用。

Objective：To analyze the timing of HMG on the outcome during IVF-ET with donor sperm.Methods：A retrospective analysis had been conducted on 371 patients treated with IVF-ET with donor sperm.All the patients underwent long protocol and controlled ovarian hyperstimulation（COH）.The patients were divided into two groups：group A（227cycles added HMG at follicle reached 14 mm）and group B（144cycles added HMG and r-FSH at the same time）.The dosage and duration of gonadotropin（Gn）used,E2 and progesterone levels on HCG day,number of retrieved oocytes,2PN rate,number of embryos,good quality embryo rate,implantation rate,clinical pregnancy rate,miscarriage rate,live birth rate were compared between the two groups.The patients were subgrouped by the age for further analysis.Results：Gn dosage and duration,progesterone levels on HCG day and good quality embryo rate in group A were significantly lower than those in group B（P〈0.05）.There were no significantly differences in E2 levels on HCG day,number of retrieved oocytes,2PN rate,number of embryos,implantation rate（P〉0.05）.Clinical pregnancy rate and live birth rate were higher in group A while miscarriage rate was lower,but there were no statistic differences（P〉0.05）.For patients younger than 35 years old,Gn dosage and duration were significantly decreased in group A（P〈0.05）.For patients older than 35 years old,good quality embryo rate was significantly higher in group B（P〈0.05）.Conclusions：For patients undergoing long protocol during late follicular phase of COH cycles,adding HMG can reduce Gn dosage and cost,however,it does not affect pregnancy outcome.