拮抗剂方案与改良超长方案在卵巢高反应人群中应用的比较

Comparison of antagonist protocol and modified super-long protocol in patients with high ovarian response

目的比较拮抗剂方案与改良超长方案在卵巢高反应患者中应用的临床疗效。方法回顾性分析2015年1月至2017年9月在本院行IVF/ICSI的卵巢高反应患者(获卵数>15个)共853个周期的临床资料。按促排卵方案分为两组,其中拮抗剂方案组186个周期、改良超长方案组667个周期。比较患者的一般情况和临床结局。结果与改良超长方案组比较,拮抗剂方案组Gn总量[(1 544.15±412.52)U vs.(2 949.87±1 156.05)U]、Gn天数[(10.08±1.33)d vs.(13.81±1.87)d]均显著减少(P<0.05),获卵数[(23.41±6.20)vs.(21.96±5.24)]、HCG日E2[(24 087.76±8 309.59)pmol/L vs.(22 281.31±6 830.78)pmol/L]均显著增高(P<0.05),HCG日P/E2值[(0.36±0.20)vs.(0.42±0.20)显著降低(P<0.05);与改良超长方案组比较,拮抗剂方案组胚胎种植率(33.20%vs.46.29%)、临床妊娠率(47.37%vs.63.80%)、抱婴率(32.33%vs.48.86%)均显著降低(P<0.05),但中重度卵巢过度刺激综合征(OHSS)发生率(8.60%vs.15.44%)、移植取消率(28.49%vs.40.78%)亦显著降低(P<0.05)。结论卵巢高反应人群中拮抗剂方案临床结局显著低于改良超长方案,可能与其降低子宫内膜容受性有关,因此应考虑全胚冻存行解冻移植使其降低OHSS风险的同时有良好的妊娠结局。

Objective:To compare the clinical efficacy of GnRH antagonist(GnRH-ant)protocol and modified super-long protocol in the patients with high ovarian response.Methods:The data of 853 IVF/ICSI cycles of the patients with high ovarian response(number of oocytes retrieved >15)in our hospital from Jan.2015 to Sep.2017 were retrospectively analyzed.According to the ovulation induction protocol,they were divided into two groups:the GnRH-ant group(n=186 cycles)and the modified super-long group(n=667 cycles).The general condition and clinical outcome of the patients were compared.Results:Compared to the modified super-long group,the total dosage[(1 544.15±412.52)vs.(2 949.87±1 156.05)U]and days of Gn used[(10.08±1.33)vs.(13.81±1.87)days]were significantly lower(P<0.05).The number of oocytes retrieved[(23.41±6.20)vs.(21.96±5.24)]and the serum E 2 levels on HCG day[(24 087.76±8 309.59)vs.(22 281.31±6 830.78)pmol/L]were significantly higher(P<0.05)and the P/E 2 value on HCG day[(0.36±0.20)vs.(0.42±0.20)was significantly lower in the antagonist group(P<0.05).The implantation rate(33.20%vs.46.29%),clinical pregnancy rate(47.37%vs.63.80%)and live birth rate(32.33%vs.48.86%)were significantly lower in the antagonist group as compared to the modified super-long group(P<0.05).The incidence of moderate and severe OHSS(8.60%vs.15.44%)and cancellation rate of transplantation(28.49%vs.40.78%)were significantly lower in the antagonist group(P<0.05).Conclusions:The clinical outcome of the antagonist protocol in patients with high ovarian response is significantly lower than that of the modified super-long protocol,which may be related to the reduction of endometrial receptivity,so it should be considered whole embryo cryopreservation for frozen-thawed transplantation to reduce the risk of OHSS to obtain good pregnancy outcome.