人绒毛膜促性腺激素注射日直径≥14 mm卵泡数比例和卵泡输出率对多囊卵巢综合征患者新鲜胚胎移植妊娠率的影响

Effect of the proportion of follicles with a diameter≥14 mm on human chorionic gonadotropin injection day and follicular output rate on the pregnancy rate of fresh embryo transfer in patients with polycystic ovary syndrome

目的探讨多囊卵巢综合征(PCOS)患者控制性超促排卵中人绒毛膜促性腺激素(hCG)注射日直径≥14 mm卵泡数比例和卵泡输出率(FORT)对卵泡期长效长方案新鲜胚胎移植妊娠结局的影响。方法回顾性队列研究分析2017年5月至2018年5月期间于郑州大学第三附属医院生殖医学中心行卵泡期长效长方案新鲜胚胎移植PCOS患者的临床资料,共计811个周期,根据hCG注射日卵泡直径≥14 mm数占比分为3组:A组,比例≤60%;B组,比例60%~80%;C组,比例≥80%。根据FORT分为3组:D组,比例≤40%;E组,比例40%~60%;F组,比例≥60%。比较各组患者的临床和实验室相关指标。按照移植结局,将患者分为妊娠组及未妊娠组,比较两组患者的临床资料,并采用二元logistic回归分析影响临床妊娠的因素。结果A、B、C 3组获卵数依次增高(P<0.001);A组的双原核(2PN)受精率(59.78%)低于B组(62.40%,P=0.013);3组胚胎种植率、临床妊娠率和活产率组间差异均无统计学意义(P均>0.05)。D、E、F 3组获卵数依次增高(P<0.001),但F组2PN受精率(59.13%)明显低于D组(62.98%,P=0.009)和E组(64.05%,P<0.001);F组胚胎种植率(51.76%)、临床妊娠率(62.72%)、活产率(52.33%)低于E组(61.56%,P=0.002;72.70%,P=0.007;61.84%,P=0.011),D组(56.77%、69.94%、59.54%)与其他两组比较差异均无统计学意义(P>0.05)。妊娠组与未妊娠组相比,hCG注射日直径≥14 mm卵泡数占比差异无统计学意义(P>0.05),而妊娠组FORT低于未妊娠组(P=0.031)。logistic回归分析显示FORT是临床妊娠的独立影响因素(OR=0.995,95%CI=0.974~1.016,P=0.039)。结论在PCOS患者中,hCG注射日直径≥14 mm卵泡数占比不影响妊娠结局;FORT对于预测妊娠结局具有重要意义,中低比例FORT组可获得较好的妊娠结局。

Objective To investigate the impact of the proportion of follicle diameter≥14 mm on human chorionic hormone(hCG)injection day and follicular output rate(FORT)on the pregnancy outcome of fresh embryo transfer in patients with polycystic ovary syndrome(PCOS)by using long-acting gonadotropin-releasing hormone agonist(GnRH-a)long protocol in follicular phase.Methods The data of 811 fresh embryo transfer cycles of PCOS patients assisted by long-acting GnRH-a long protocol in follicular phase were analyzed retospectively from May 2017 to May 2018 in the Center for Reproductive Medicine of the Third Affiliated Hospital of Zhengzhou University.According to the proportion of follicles with a diameter≥14 mm on hCG injection day,patients were divided into three groups:group A(proportion≤60%),group B(proportion 60%-80%)and group C(proportion≥80%).According to the FORT,patients were divided into three groups:group D(proportion≤40%),group E(proportion 40%-60%)and group F(proportion≥60%).The clinical and laboratory indicators of patients in each group were compared and analyzed.According to the pregnancy outcomes,patients were divided into pregnancy group and non-pregnancy group.The clinical data of the two groups were compared,and the influencing factors of clinical pregnancy outcomes were analyzed by binary logistic regression.Results The number of retrieved oocytes of groups A,B and C increased in turn(P<0.001).The fertility rate of two pronuclei(2PN)in group A(59.78%)was lower than that in group B(62.40%,P=0.013).There was no significant difference among the three groups in embryo implantation rate,clinical pregnancy rate and live birth rate(P>0.05).The number of retrieved oocytes in groups D,E and F increased(P<0.001),but the 2PN rate in group F(59.13%)was significantly lower than that in group D(62.98%,P=0.009)and group E(64.05%,P<0.001).Embryo implantation rate,clinical pregnancy rate and live birth rate in group F were lower than those in group E(51.76%vs.61.56%,P=0.002;62.72%vs.72.70%,P=0.007;52.33%vs.61.84%,P=0.011),while those in group D(56.77%,69.94%,59.54%)were not significantly different from those in the other two groups(P>0.05).Compared with pregnancy group,the proportion of dominant follicles on hCG injection day in non-pregnancy group was not significantly different(P>0.05),while FORT in pregnancy group was lower than that in non-pregnancy group(P=0.031).Logistic regression analysis showed that FORT was an independent influencing factor for clinical pregnancy[OR=0.995,95%CI=0.974-1.016,P=0.039].Conclusion In PCOS patients,the proportion of follicles with a diameter≥14 mm on hCG injection day does not affect pregnancy outcomes,the FORT is of great significance in predicting pregnancy outcomes,and the middle and low proportion of FORT group can obtain better pregnancy outcomes.