IVF卵泡期长效长方案与黄体期短效长方案累积妊娠率的比较

Comparison of cumulative pregnancy rate between follicular phase long-acting long protocol and luteal phase short-acting long protocol in IVF

目的比较体外受精-胚胎移植(IVF-ET)卵泡期长效长方案与黄体期短效长方案新鲜移植周期的临床结局及单个取卵周期的累积妊娠率及活产率。方法收集2017年1月至2018年12月在广东省计划生育科学技术研究所生殖医学中心行IVF助孕且周期完整的患者资料,根据其促排卵方案分成卵泡期长效长方案组(A组)及黄体期短效长方案组(B组),采用倾向性评分(propensity score matching,PSM)匹配两组患者基线,A组共323个周期,B组共319个周期,比较两组患者新鲜移植周期的促排情况、临床妊娠结局以及单个取卵周期的累积妊娠率和活产率。结果两组患者的基本情况均无显著性差异。促排卵情况,与B组相比,A组HCG日E2[(7721.57±3663.68)pmol/L vs.(8480.05±4156.57)pmol/L]、LH水平[(0.80±0.59)U/L vs.(1.41±0.72)U/L]显著下降,Gn使用天数[(10.61±1.78)vs.(9.47±4.35)]、获卵数[(13.02±6.21)vs.(9.27±4.24)]、MⅡ卵数[(11.63±5.97)vs.(7.89±3.92)]、可移植胚胎数[(5.15±3.78)vs.(3.32±1.75)]、正常受精率[(73.65%vs.65.26%)、优胚率(79.90%vs.65.19%)均显著升高(P<0.05)。妊娠结局比较,A组新鲜周期临床妊娠率(62.96%vs.57.58%)、活产率(53.43%vs.47.32%)、累积妊娠率(83.59%vs.73.67%)、累积活产率(68.11%vs.57.99%)均高于B组,但无显著性差异(P>0.05)。结论卵泡期长效长方案可以获得更多优质胚胎,新鲜移植周期临床结局及累积妊娠率和活产率均不劣于经典黄体期短效长方案,可作为临床优选方案之一。

Objective:To compare the clinical outcomes,cumulative pregnancy rate,and live birth rate between follicular phase long-acting long protocol and luteal phase short-acting long protocol in fresh embryo transfer cycle of IVF/ICSI.Methods:The data of patients who underwent IVF and complete cycle in the Reproductive Medicine Center of Guangdong Institute of Family Planning Science and Technology from January 2017 to December 2018 were collected.The cycles were divided into follicular phase long-acting long protocol(group A,n=323)and luteal phase short-acting long protocol(group B,n=319)according to the controlled ovarian stimulation protocol.Propensity score matching(PSM)analysis was used to matched the baseline characteristics of two groups.The status of induction ovulation,clinical pregnancy outcome,and cumulative pregnancy rate and live birth rate of per oocyte retrieval cycle in the fresh transplant cycle were compared between the two groups.Results:The basic conditions of the patients of two groups were not significantly different.The E2 level[(7721.57±3663.68 vs.8480.05±4156.57)pmol/L],LH level[(0.80±0.59 vs.1.41±0.72)U/L]on HCG day were significantly decreased(P<0.05).The days of gonadotropin(Gn)used[(10.61±1.78)vs.(9.47±4.35)days],number of oocytes retrieved[(13.02±6.21 vs.(9.27±4.24)],number of MII oocytes[(11.63±5.97)vs.(7.89±3.92)],number of transferable embryo[(5.15±3.78 vs.(3.32±1.75)],2PN fertilization rate(73.65%vs.65.26%),high quality embryo rate(79.90%vs.65.19%)were significantly increased(P<0.05).The clinical pregnancy rate(62.96%vs.57.58%),live birth rate(53.43%vs.47.32%),cumulative pregnancy rate(83.59%vs.73.67%)and cumulative live birth rate(68.11%vs.57.99%)of fresh embryo transfer cycle in group A were higher than group B,but no significant difference was found(P>0.05).Conclusions:Follicular phase long-acting long protocol can obtain more high quality embryos;Their clinical outcome and cumulative pregnancy rate and live birth rate of the fresh transplantation cycle are not inferior to the classic luteal phase short-acting long protocol,which can be used as one of the clinically preferred protocols.