正常反应患者拮抗剂方案相较于激动剂长方案的临床特点及获卵率相关因素分析

Clinical efficacy of GnRH antagonist protocol vs. GnRH-agonist down-regulation protocol in normal response patients and the relevant factors of occytes retrieved

目的分析体外受精-胚胎移植(IVF-ET)中正常反应者采用拮抗剂方案相较于激动剂长方案的临床特点及寻找与获卵率相关的因素。方法回顾性分析2015年1月至2017年6月汕头市中心医院生殖中心拮抗剂方案和激动剂长方案各150周期,比较两组的基本资料和临床结局。结果拮抗剂组的Gn时间、获卵数、获卵率、OHSS发生率低于激动剂组(P<0.05);拮抗剂组启动剂量、受精率、卵子利用率高于激动剂组(P<0.05);两组的Gn用量、优胚数、优胚率、妊娠率、流产率;HCG日E2、LH、P差异均无统计学意义(P>0.05)。拮抗剂组扳机次日的孕酮值是最重要的获卵率独立预测指标,孕酮值越高获卵率越好,孕酮的cut-off值为31 nmol/L。结论对正常反应者,拮抗剂方案较激动剂长方案有优势;扳机后次日的孕酮值对获卵率有较好的预测价值。

Objective To compare the clinical efficacy between GnRH antagonist protocol and GnRH- agonist down-regulation protocol in normal response patiens, and analye the relevant factor of oecytes retrieved. Methods The data of 146 IVF-ET cycles in the Center for Clinical Reproductive Medicine from January 2014 to January 2016 were analyzed retrospectively. Among them, 73 cycles were administered in GnRH-ant protocol （group A）, while another 73 cycles were administered in down-regulation short GnRH-agonist protocol （group B）. The clinical outcomes of all groups were analyzed and compared. Results The duration of gonadotropin （Gn） used, number of occytes retrieved, cleavage rate, rate of ovarian hyperstimulation syndrome （OHSS） in group A were significantly lower than those in group B （P 〈 0.05）. The initial dose of gonadotropins, fertilization rate, available oocytes rate in group A was significantly higher than those in group B （P 〈 0.05 ）. There were no statisti- cal differences between the groups in total Gn dose, number of high-quality embryo, high-quality embryo rate, pregnancy rate, abortion rate, E2 levels, P levels, LH lebels （P 〉 0.05）. P levels on the next day after HCG injection （HCG day） were the most important independent prognostic factor in cleavage rate. In particular, the cleavage rate was as high as P levels on the next day after HCG injection. The P cut-off value was 31 nmol/L. Conclusion For normal response patiens, GnRH antagonist protocol is better than down-regulation short GnRH- agonist protocol. P levels on the next day after HCG injection has predictive value for cleavage rate.