GnRH拮抗剂方案对新鲜移植周期子宫内膜容受性影响的回顾性分析

Effect of GnRH Antagonist on the Endometrial Receptivity in Fresh Embryo Transfer Cycle: A Retrospective Study

目的:通过回顾性分析应用促性腺激素释放激素激动剂(GnRHa)长方案或GnRH拮抗剂(GnRH_A)方案进行体外受精-胚胎移植(IVF-ET)助孕的患者,比较2种方案的人绒毛膜促性腺激素(hCG)日子宫内膜厚度、临床妊娠率和胚胎着床率等相关指标,以期寻找GnRH_A是否会对子宫内膜容受性产生影响的临床证据。方法:选择2015年1月—2017年6月于大连市妇女儿童医疗中心第一周期行IVF-ET助孕,应用GnRHa长方案(长方案组,1 459例)或者GnRH_A方案(拮抗剂方案组,395例)的患者。比较2组患者的基本特征,根据年龄分为<30岁组(352例),30~35岁组(781例),35~40岁组(601例)及≥40岁组(120例);根据获卵数分为低反应组(获卵≤3枚,218例),正常反应组(获卵4~14枚,1 535例)、高反应组(获卵≥15枚,101例);比较各组患者h CG日子宫内膜厚度、临床妊娠率、胚胎着床率、早期流产率。结果:长方案组与拮抗剂方案组患者的体质量指数(BMI)差异无统计学意义(P>0.05),但年龄、不孕年限、基础卵泡刺激素(bFSH)、窦卵泡数(AFC)和平均移植胚胎数比较,差异有统计学意义(均P<0.05)。<30岁及≥40岁的人群,2种方案的h CG日子宫内膜厚度、胚胎着床率比较,差异无统计学意义(均P>0.05),<30岁人群长方案组临床妊娠率高于拮抗剂方案组(P<0.05)。30~35岁及35~40岁人群,长方案组h CG日子宫内膜厚度、胚胎着床率和临床妊娠率高于拮抗剂方案组,差异有统计学意义(均P<0.05)。在低反应组中长方案移植胚胎数少,胚胎着床率高,差异有统计学意义(均P<0.05)。在正常卵巢反应组中,长方案hCG日子宫内膜厚度、胚胎着床率和临床妊娠率大于拮抗剂方案组,差异有统计学意义(均P<0.05)。在卵巢高反应组2种方案各项指标比较差异无统计学意义(均P>0.05)。结论:在30~40岁及正常卵巢反应人群拮抗剂方案可能降低子宫内膜容受性,减少胚胎着床率及临床妊娠率。

Objective:To evaluate the endometrial thickness on the day of hCG injection(the hCG day),clinical pregnancy rate and embryo implantation rate in those patients undergoing the in vitro fertilization-embryo transfer(IVF-ET)with the GnRHa long protocol or GnRH antagonist(GnRHA)protocol,in order to find whether GnRHA has a negative effect on endometrial receptivity.Methods:Those cases with the GnRHa long protocol(the long-protocol group,1 459 cases)or the GnRHA protocol(the GnRHA group,395 cases)in our Center from January 2015 to June 2017 were enrolled.The basic characteristics of the two groups were compared.According to the age,patients were divided into four subgroups:the<30 years old group(352 cases),the 30-35 years old group(781 cases),the 35-40 years old group(601 cases)and the≥40 years old group(120 cases).According to the number of eggs,patients were divided into three subgroups:the low response group(oocytes≤3 218 cases),the normal response group(oocytes 4-14,1 535 cases)and the high response group(oocytes≥15 101 cases).The endometrial thickness on the hCG day,clinical pregnancy rate,embryo implantation rate and early abortion rate were compared.Results:There was no significant difference in BMI between the two groups(P>0.05).There were significant differences between the two groups in years,infertility years,the basic level of FSH,AFC and average implanted embryos number(P<0.05).In those cases of the<30 years old subgroup and the≥40 years old subgroup,the differences in the endometrial thickness on the hCG day and embryo implantation rate between the two groups were no significant(P>0.05),while the difference in the clinical pregnancy rate was significant in the<30 years old group(P<0.05).In those cases of the 30-35 and 35-40 years old subgroups,the endometrial thickness,embryo implantation rate and clinical pregnancy rate in the GnRHa long protocol group were significantly higher than those in GnRHA protocol group(P<0.05).In those cases of the low response subgroups,there were less transplanted embryos and higher embryo implantation rate in the GnRHa long protocol group(P<0.05).In those cases of the normal response subgroups,the endometrial thickness on the hCG day,embryo implantation rate and the clinical pregnancy rate were higher in the GnRHa long prolocol group(P<0.05).In those cases of the high response subgroups,there were no significant differences between the two groups.Conclusions:In those cases of the 30-40 year old and normal ovarian response population,the GnRHA protocol may reduce the endometrial receptivity,and to reduce the embryo implantation rate and clinical pregnancy rate.