拮抗剂方案与早卵泡期长效长方案应用于波塞冬2型POR患者IVF-ET结局的比较

Comparison of IVF-ET outcomes between antagonist protocol and long protocol in early follicular phase in patients with poor ovarian response of POSEIDON type Ⅱ

目的比较拮抗剂方案和早卵泡期长效长方案在波塞冬2型卵巢低反应(POR)患者体外受精-胚胎移植(IVF-ET)中的应用效果。方法回顾性分析2016年9月至2019年3月在本中心行IVF-ET助孕的波塞冬2型POR患者的197个新鲜周期的临床资料。根据促排卵方案不同分为:拮抗剂方案组(A组,94个周期),早卵泡期长效长方案组(B组,103个周期),比较两组的基本资料和临床妊娠结局。结果两组患者的一般资料比较均无显著性差异(P>0.05)。两组的促排卵实验室指标比较,A组的Gn总量[(2100.27±636.11)vs.(3064.71±877.76)U]和Gn天数[(7.99±1.88)vs.(11.37±2.93)d]显著低于B组(P<0.05);A组HCG日LH水平[(3.09±2.22)vs.(1.29±1.00)U/L]显著高于B组,HCG日内膜厚度[(9.45±2.39)vs.(10.51±2.66)mm]显著低于B组(P<0.05);A组的优势卵泡数[(5.16±2.57)vs.(7.42±3.58)]、获卵数[(6.67±3.51)vs.(8.34±4.28)]、MⅡ数[(5.68±3.19)vs.(7.11±4.20)]、正常2PN数[(3.98±2.35)vs.(4.94±2.92)]、D3可移植胚胎数[(2.60±2.22)vs.(3.45±2.31)]均显著低于B组(P<0.05)。两组的妊娠结局比较,移植取消率(55.32%vs.41.75%)、着床率(35.14%vs.35.85%)、临床妊娠率(54.76%vs.46.67%)、早期流产率(17.39%vs.17.86%)、宫外孕率(0.00%vs.3.57%)及中重度OHSS发生率(0.00%vs.0.00%)组间比较均无显著性差异(P>0.05)。结论对于波塞冬2型POR患者,拮抗剂方案和早卵泡期长效长方案新鲜周期有相似的临床结局,但拮抗剂方案可以节约Gn用量、缩短Gn天数,缩短治疗周期,减轻患者的经济负担和精神压力。因此,拮抗剂方案可以作为波塞冬2型POR患者促排卵方案的选择之一。

Objective:To compare the IVF-ET outcomes between antagonist protocol and long protocol in early follicular phase in the patients with poor ovarian response(POR)of POSEIDON typeⅡ.Methods:The data of 197 fresh cycles of POR patients with POSEIDON typeⅡwho underwent IVF-ET in our center from Sep.2016 to Mar.2019 were retrospectively analyzed.According to stimulate ovulation protocol,the cycles were divided into two groups:antagonist protocol group(group A,94 cycles)and long protocol in early follicular phase group(group B,103 cycle).The basic data and clinical outcome were compared among the two groups.Results:There was no significant difference in general information between the two groups(P>0.05).In terms of the laboratory indicators of ovulation induction,the total amount of Gn used[(2100.27±636.11)vs.(3064.71±877.76)U]and Gn days[(7.99±1.88)vs.(11.37±2.93)days]in group A were significantly less than those in group B(P<0.05).The LH level on HCG day of group A[(3.09±2.22)vs.(1.29±1.00)U/L]was significantly higher and endometrial thickness on HCG day of group A[(9.45±2.39)vs.(10.51±2.66)mm]was significantly thinner than those of group B(P<0.05).The number of dominant follicles[(5.16±2.57)vs.(7.42±3.58)],number of oocytes retrieved[(6.67±3.51)vs.(8.34±4.28)],number of mature oocytes(MⅡ)[(5.68±3.19)vs.(7.11±4.20)],number of 2PN embryos[(3.98±2.35)vs.(4.94±2.92)]and number of Day3 transplantable embryos[(2.60±2.22)vs.(3.45±2.31)]in group A were significantly less than those in group B(P<0.05).In terms of clinical pregnancy outcome,there were no significant differences in the cancellation rate of transplantation(55.32%vs.41.75%),implantation rate(35.14%vs.35.85%),clinical pregnancy rate(54.76%vs.46.67%),early abortion rate(17.39%vs.17.86%),ectopic pregnancy rate(0.00%vs.3.57%),and moderate to severe OHSS incidence(0.00%vs.0.00%)between the two groups(P>0.05).Conclusions:For the patients with POR of POSEIDON typeⅡ,antagonists protocol and long protocol in early follicular phase have similar clinical outcomes in the fresh cycle,but antagonists protocol can save Gn dosage,shorten Gn days,greatly shorten the treatment cycle,and reduce the financial burden and mental pressure of patients.Therefore,antagonist protocol can be one of the options for ovulation promotion for the patients with POR of POSEIDON typeⅡ.