辅助生殖技术早卵泡期长效长方案中添加拮抗剂的妊娠结局分析

Analysis of pregnancy outcome of early follicular phase long-acting long protocol with antagonist in assisted reproductive technology

目的探讨在体外受精/卵细胞浆内单精子注射(in vitro fertilization/in tracyto-plasmic sperm injection,IVF/ICSI)控制性超促排卵(controlled ovarian hyperstimulation,COH)时使用早卵泡期长效长方案添加拮抗剂对妊娠结局的影响。方法回顾性分析2017年1月至2020年2月于河南省人民医院生殖中心就诊的使用早卵泡期长效长方案的患者的临床资料,在卵泡发育后期部分患者的促黄体生成素(Luteinizing hormone,LH)升高,根据LH升高后是否添加拮抗剂将患者分为两组:观察组(164个周期)和对照组(133个周期),比较两组一般基础情况、控制性超促排卵、实验室结局及临床妊娠结局。结果观察组的获卵数、MII卵子数、2PN数均高于对照组,差异有统计学意义(P<0.05);观察组的促性腺激素(gonadotropin,Gn)总量、Gn天数显著高于对照组(P<0.05);两组之间的一般基础情况及卵巢敏感指数(Ovarian sensitivity index,OSI)差异均无统计学意义(P>0.05),观察组的新鲜移植的临床妊娠率(60.44%)低于对照组(61.63%),而观察组的生化妊娠率(64.84%)高于对照组(62.79%),差异均无统计学意义(P>0.05)。结论在早卵泡期长效长方案中卵泡发育后期因LH升高添加拮抗剂可以改善获卵数、成熟卵子数、正常受精数,且添加拮抗剂后不影响临床结局,因此,在临床实践中,对于使用早卵泡期长效长方案的患者,卵泡发育后期LH升高,可适当选择添加拮抗剂。

Objective To study the effect of follicular phase long-acting long protocol with antagonist on pregnancy outcome in IVF/ICSI controlled ovarian hyperstimulation(COH).Methods A retrospective analysis of the clinical data of patients who used the early follicular phase long-acting long protocol in the Reproductive Center of Henan Provincial People’s Hospital from January 2017 to February 2020 Luteinizing hormone is elevated in some patients during late follicular development.According to whether the antagonist was added after LH increased, the patients were divided into two groups: observation group(164 cycles), control group(133 cycles), and compare the general basic conditions and controllability laboratory outcome and clinical pregnancy outcome between the two groups.Results The number of eggs obtained, the number of MII eggs, and the number of 2 PN in the observation group were higher than those of the control group, with statistical differences(P<0.05);The total amount of gonadotropin(Gn) and the number of Gn days of the observation group were significantly higher than those of the control group Group(P<0.05);there was no statistical difference in general basic conditions and ovarian sensitivity index(Ovarian sensitivity index, OSI) between the two groups(P>0.05). The clinical pregnancy rate of fresh transplantation in the observation group(60.44%) was lower than that of the control group(61.63%), while the biochemical pregnancy rate(64.84%) of the observation group was higher than that of the control group(62.79%), there was no statistical difference(P>0.05).Conclusion In the early follicular phase long-acting long protocol, the addition of an antagonist due to the increase of LH in the later stage of follicular development can improve the number of eggs obtained, the number of mature eggs, and the number of normal fertilization, and the addition of the antagonist does not affect the clinical outcome. Therefore, in clinical practice,for patients who use the long-acting protocol in the early follicular phase, LH increases in the later stage of follicular development, and antagonists can be appropriately selected to be added.