三种促排卵药物在体外受精-胚胎移植/卵胞质内单精子注射中对治疗结局的影响

The effects of three ovulation⁃induction drugs on treatment outcomes in IVF⁃ET/ICSI

目的比较三种促排卵药物在体外受精-胚胎移植/卵胞质内单精子注射(IVF-ET/ICSI)中对治疗结局的影响。方法回顾性分析上海交通大学医学院附属国际和平妇幼保健院辅助生殖中心自2016年6月至2018年4月采用拮抗剂方案行IVF-ET/ICSI治疗的病人153例,共153个周期,按促性腺激素(Gn)药物种类不同分为尿促卵泡素(u-FSH)组(50个周期)、重组人促卵泡激素α(r-FSHα)组(53个周期)和重组人促卵泡激素β(r-FSHβ)组(50个周期)。比较三组的一般情况、总Gn药物使用量和使用天数(Gn天数)、人绒毛膜促性腺激素(HCG)日激素水平及子宫内膜厚度、获卵数、可移植胚胎数、优质胚胎数、生化妊娠率、流产率、多胎妊娠率、活产率和周期取消率。结果三组的一般情况及生化妊娠率、流产率、多胎妊娠率、活产率及周期取消率差异无统计学意义(P>0.05)。u-FSH组的HCG日血清雌二醇水平(9 006.160±5 372.797)pmol/L明显低于rFSHα组(11 535.113±5 459.132)pmol/L和r-FSHβ组(13 816.340±7 388.485)pmol/L(P<0.05)。u-FSH组的Gn费用(3183.914±804.838)元明显低于r-FSHα组(5 171.643±1 235.640)元和r-FSHβ组(3 594.875±755.633)元(P<0.05)。结论在IVF-ET/ICSI治疗中,u-FSH具有与r-FSHα和r-FSHβ等同的多胎妊娠率和活产率,且促排卵作用相对较温和,价格更便宜,经济性更高。

Objective To compare the effects of three ovulation⁃induction drugs on the outcome of in vitro fertilization⁃embryo trans⁃fer/intracytoplasmic sperm injection(IVF⁃ET/ICSI).Methods A retrospective analysis was conducted on 153 patients who under⁃went IVF⁃ET/ICSI treatment with the antagonist regimen from June 2016 to April 2018 in the Assisted Reproductive Center of the International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiaotong University,with a total of 153 cycles.Ac⁃cording to the types of gonadotropin(Gn)drugs used,patients were divided into three groups:recombinant FSHαgroup(n=53),re⁃combinant FSHβ(n=50),and urinary FSH group(n=50).Gonadotrophin(Gn)total doses,Gn medication days,hormone levels and endometrial thickness on the day of human chorionic gonadotropin(HCG)administration,the number of oocytes retrieved,the number of transplanted embryos,the number of optimal embryos,biochemical pregnancy rate,abortion rate,multiple pregnancy rate,live birth rate and cycle cancellation rate were observed among the three groups.Results There was no significant difference in general characteristics,biochemical pregnancy rate,abortion rate,multiple pregnancy rate and live birth rate among three groups(P>0.05).The serum estradiol(E2)level on the day of HCG administration in group u⁃FSH was(9006.160±5372.797)pmol/L,which was significantly lower than those in the group r⁃FSHα(11535.113±5459.132)pmol/L and group r⁃FSHβ(13816.340±7388.485)pmol/L(P<0.05).The overall cost of gonadotropin in group u⁃FSH was(3183.914±804.838)yuan,which was signifi⁃cantly lower than those in the group r⁃FSHα(5171.643±1235.640)yuan and group r⁃FSHβ(3594.875±755.633)yuan(P<0.05).Conclusions U⁃FSH is relatively mild in promoting ovulation,with multiple pregnancy rates and live birth rates equivalent to r⁃FSHαand r⁃FSHβin IVF⁃ET/ICSI treatment.At the same time,it is cheaper and more economic than r⁃FSHαand r⁃FSHβ.