口服避孕药预处理时间对预期卵巢低反应患者临床结局的影响

Effect of pretreatment duration of oral contraceptive pills on clinical outcomes in the patients with expected poor ovarian response

目的探讨短效口服避孕药(OCP)预处理时间对POSEIDON标准的预期卵巢低反应(POR)患者IVF结局的影响。方法回顾性分析2016年1月至2018年6月就诊于北医三院生殖医学中心接受IVF-ET、符合POSEIDON标准预期POR患者的167个IVF周期的临床资料。所有患者均采用OCP预处理(7~30 d)后超短GnRH激动剂联合拮抗剂方案,按照OCP预处理时间不同分为A组(OCP预处理时间≤16 d,n=107)、B组(OCP预处理时间>16 d,n=60),比较两组患者的一般资料、促排卵周期指标及临床妊娠率等。结果两组患者年龄、不孕年限、不孕类型、BMI、基础FSH、AMH、IVF周期数及排卵障碍比例比较均无统计学差异(P>0.05)。A组窦卵泡数(AFC)显著低于B组[(2.2±1.8)vs.(2.9±2.3),P=0.028];相对于B组,A组Gn起始剂量[(273.8±46.5)U vs.(290.4±59.3)U]、促排卵时间[(9.5±2.6)d vs.(10.4±2.6)d]及Gn总量[(2648.4±858.8)U vs.(3036.6±1009.0)U]均显著降低(P<0.05),而两组间HCG日血清激素水平(E 2、LH、P)、子宫内膜厚度、获卵数、ICSI率、受精率、卵裂率、可移植胚胎数、优胚率、移植胚胎数及周期取消率均无统计学差异(P>0.05)。A组鲜胚移植周期着床率和临床妊娠率均显著高于B组(32.2%vs.12.7%;42.4%vs.17.6%)(P<0.05),而A、B两组冻融胚胎移植周期的着床率(32.1%vs.40.0%)和临床妊娠率(45.0%vs.40.0%)比较均无统计学差异(P>0.05),且两组间早期流产率在鲜胚移植周期和冻融胚胎移植周期均无统计学差异(P>0.05)。结论POSEIDON预期POR患者超短GnRH激动剂联合拮抗剂方案前OCP预处理>16 d,鲜胚移植周期的妊娠率明显下降,且增加卵巢刺激时间及Gn用量,增加患者经济负担,但并不影响冻融胚胎移植周期的妊娠率。建议OCP预处理不超过16 d。

Objective:To explore the effect of pretreatment duration of oral contraceptive pills(OCP)on the IVF outcomes in the patients with expected poor ovarian response(POR)defined by the POSEIDON criteria.Methods:The clinical data of 167 IVF cycles in the expected POR patients who fulfilled the POSEIDON criteria and had undertaken IVF-ET cycles in Center for Reproductive Medicine,Peking University Third Hospital from January 2016 to June 2018 were retrospectively analyzed.All patients were treated with OCP pretreatment(7-30 days),followed by ultra-short GnRH agonist combined with antagonist protocol.According to the duration of OCP pretreatment,they were divided into group A(OCP pretreatment duration≤16 days,n=107),group B(OCP pretreatment duration>16 days,n=60).The general information,the indices of ovarian stimulation cycles,and the clinical outcomes of two groups were compared.Results:There were no significant differences in patients’age,duration of infertility,type of infertility,BMI,basic FSH levels,AMH levels,the number of IVF cycles and the proportion of ovulation disorders between the two groups(P>0.05).The number of antral follicle counts(AFC)in group A was significantly fewer than that in group B[(2.2±1.8)vs.(2.9±2.3),P=0.028].The initial dose of Gn[(273.8±46.5)U vs.(290.4±59.3)U],duration of ovarian stimulation[(9.5±2.6)d vs.(10.4±2.6)d]and total dosage of Gn[(2648.4±858.8)U vs.(3036.6±1009.0)U]were significantly lower in group A than in group B(P<0.05).There were no significant differences in serum estrogen levels,serum LH levels,serum progestrone levels,endometrial thickness on the day of HCG,or the number of oocytes retrieved,ICSI rate,fertilization rate,cleavage rate,number of embryos available for transfer,good quality embryos rate,the number of embryo transfer cycles,the number of embryos transferred and the cancellation rate between the two groups(P>0.05).The implantation rate and clinical pregnancy rate of fresh embryo transfer cycles were significantly higher in group A than those in group B(32.2%vs.12.7%and 42.4%vs.17.6%,respectively)(P<0.05).There was no significant difference in the implantation rate or the clinical pregnancy rate in frozen embryo transfer cycle between the two groups(32.1%vs.40.0%and 45.0%vs.40.0%,respectively)(P>0.05).There was no significant difference in early pregnancy loss rates between group A and B either in fresh embryo transfer cycle or frozen embryo transfer cycle(P>0.05).Results:The longer OCP pretreatment duration(≥16 d)in the expected POR patients could result in the decreased pregnancy rate of the fresh embryo transfer cycles and the increased duration of ovarian stimulation and total dosage of Gn.It is recommended that the OCP pretreatment should not be more than 16 days.