卵巢正常反应人群拮抗剂方案中月经周期长短对卵泡发育同步化的影响

Influence of menstrual cycle length on follicle developmental synchronization in GnRH antagonist protocol in patients with normal ovarian response

目的探讨月经周期的长短在采用拮抗剂方案的卵巢正常反应人群中对卵泡发育同步化的影响。方法回顾性分析2014年1月至2015年11月期间在武汉大学人民医院生殖中心接受IVF/ICSI-ET助孕治疗的236例采取拮抗剂方案促排卵且卵巢反应正常的患者,按月经周期的长短分为短周期组(≤28d,101例)和长周期组(≥29d,135例),分析患者启动促性腺激素(Gn)日、Gn启动后第4天、第7天及HCG日卵泡平均直径的变异系数(CV)、IVF助孕情况及妊娠结局。结果与短周期组比较,长周期组患者平均年龄、BMI、Gn天数、HCG日雌二醇水平、内膜厚度、Gn启动日及Gn刺激第4天卵泡平均直径CV、受精率、卵裂率、优胚率、种植率、临床妊娠率均无显著差异(P>0.05);长周期组的窦卵泡个数(AFC)[(14.98±4.24)vs.(11.72±4.29)]及基础黄体生成素(bLH)水平[(4.39±2.28)U/L vs.(3.60±1.51)U/L]、HCG日直径≥14mm卵泡数[(10.06±2.19)vs.(9.98±2.04)]、获卵数[(11.81±4.32)vs.(9.65±4.33)]均明显高于短周期组(P<0.05),而基础卵泡刺激素(bFSH)水平[(6.38±1.24)U/L vs.(6.81±1.53)U/L]、Gn刺激第7天卵泡平均直径CV[(0.122±0.045)vs.(0.143±0.055)]、HCG日卵泡平均直径CV[(0.208±0.037)vs.(0.218±0.041)]、Gn总量[(24.88±7.46)U vs.(29.14±9.56)U]、HCG日孕酮水平[(3.78±2.61)nmol/L vs.(4.45±2.23)nmol/L]均显著低于短周期组(P<0.05)。结论采用拮抗剂方案促排的卵巢正常反应人群,月经周期较长者促排后卵泡发育同步性可能更好、获卵数更多。

Objective： To investigate the influence of the length of menstrual cycle on follicle developmental synchronization in GnRH antagonist protocol in patients with normal ovarian response. Methods： The data of 236 infertile patients with normal ovarian response undergone IVF/ICSI-ET with GnRH antagonist protocol in Renmin Hospital of Wuhan University from January 2014 to November 2015 were retrospectively analyzed. The patients were divided into two groups according to the length of menstrual cycle ： short menstrual cycle group （≤28 days, n = 101） and long menstrual cycle group （≥ 29 day,n= 135）. The coefficient of variation of the follicular diameters on the initial day of using gonadotropin （Gn）,Day 4,Day 7 after using Gn and HCG day, the clinical outcome were compared between the two groups. Results： The age, BMI, duration of gonadotropin （Gn） stimulation, estradiol level ＆ endometrial thickness on HCG day,the coefficient of variation of the follicular diameters on the initial day of using Gn and Day 4 after using Gn, fertilization rate, cleavage rate, high qualified embryo rate,implantation rate, clinical pregnancy rate were not significantly different between two groups （P〉0.05）. The antral follicle count[（14.98±4.24）vs. （11.72±4.29）],basal LH levels [（4.39±2.28）vs. （3.60±1.51）U/L],number of follicular diameters514 mm [（10.06±2.19）vs. （9.98±2.04）],number of oocytes retrieved[（11.81± 4.32）vs. （9.65±4.33）1 in the long menstrual cycle group were significantly higher than those in the short menstrual cycle group（P〈0.05）. In contrast, basal FSH levels [（6.38± 1.24） vs. （6.81 ± 1.53）], the coefficient of variation of the follicular diameters on Day 7 after Gn stimulating [（0. 122 ± 0. 045）vs. （0. 143 ± 0. 055）] and HCG day [（0. 208±0. 037）vs. （0. 218±0. 041）],the total does of Gn used [（24. 88±7. 46） vs. （29.14±9.56）],progesterone levels on HCG day [（3.78±2.61） vs. （4.45±2.23）nmol/L] in the long menstrual cycle group were significantly lower than those in the short menstrual cycle group（P〈0.05）. Conclusions： Among infertile female with normal ovarian response in GnRH antagonist protocol,the women with longer menstrual cycle may have better follicular developmental synchronization and obtained more retrieved oocytes.