生长激素在波塞冬标准下非预期卵巢低反应人群中应用对妊娠结局的影响

Effect of growth hormone on pregnancy outcome of IVF-ET in patients with unexpected poor ovarian response under Poseidon standard

目的探讨生长激素(GH)在波塞冬标准下非预期卵巢低反应(POR)人群中应用对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法回顾性分析2017年1月至2020年5月在河南省人民医院行IVF-ET助孕的波塞冬1型(PG1)及2型(PG2)非预期POR患者新鲜周期的临床资料,根据患者是否使用GH分为GH组(96个周期)及对照组(96个周期),比较两组患者的一般资料、促排卵情况及临床妊娠结局。结果GH组与对照组患者的一般资料比较均无显著性差异(P>0.05)。两组的促排卵情况比较,Gn启动剂量、Gn总量、Gn总天数,获卵数,成熟卵母细胞数、正常受精数均无显著性差异(P>0.05);GH组的D3可利用胚胎数显著低于对照组[(2.78±2.47)vs.(3.86±3.07),P<0.05]。GH组与对照组的无可利用胚胎周期取消率、女方移植年龄、移植日内膜厚度、移植胚胎数、D3移植周期数、胚胎种植率、生化妊娠率、临床妊娠率均无显著性差异(P>0.05);GH组的新鲜周期移植率显著高于对照组(54.64%vs.37.11%,P<0.05)。PG1及PG2型患者中GH组与对照组的平均年龄、体重指数(BMI)、基础窦卵泡计数(AFC)、基础FSH(bFSH)、bLH、不孕年限、Gn启动剂量、Gn总量、Gn总天数、获卵数、成熟卵母细胞数、正常受精数均无显著性差异(P>0.05);PG1型患者中GH组的D3可利用胚胎数显著低于对照组[(3.07±2.89)vs.(4.84±3.55),P<0.05]。PG1及PG2型患者中GH组与对照组的新鲜周期移植率、移植年龄、移植日内膜厚度、移植胚胎数、D3移植周期数、胚胎种植率、生化妊娠率及临床妊娠率均无显著性差异(P>0.05)。结论对于PG1和PG2型非预期POR患者,取卵前使用GH预处理可增加患者的新鲜周期移植率,有提高患者生化妊娠率和临床妊娠率的趋势,但其是否能改善卵巢反应性及改善妊娠结局尚需进一步研究。

Objective:To explore the effects of growth hormone(GH)on the pregnancy outcome of IVF-ET in patients with unexpected poor ovarian response under Poseidon standard.Methods:The clinical data of patients with unexpected poor ovarian response of Poseidon typeⅠ(PG1)and typeⅡ(PG2)who underwent IVF-ET in Henan Provincial People’s Hospital from January 2017 to May 2020 were analyzed retrospectively.According to whether usage of GH,the patients were divided into GH group and control group,96 patients for each group.The basic data,ovulation induction and clinical pregnancy outcomes of the two groups were compared.Results:There was no significant difference in general conditions between GH group and control group(P>0.05).There were no significant differences in Gn starting dose,Gn total amount,Gn total days,number of oocytes retrieved,number of mature oocytes and number of 2PN embryos between the two groups(P>0.05).The number of available Day 3 embryos[(2.78±2.47)vs.(3.86±3.07)]in GH group was significantly lower than that in control group(P<0.05).There were no significant differences in the cycle cancellation rate due to no available embryo transfer,the female age,endometrial thickness on transplantation day,the number of embryos transferred,Day 3 transplantation cycles,embryo implantation rate,biochemical pregnancy rate and clinical pregnancy rate between GH group and control group(P>0.05).The transplantation rate of fresh cycle(54.64%vs.37.11%)in GH group was significantly higher than that in control group(P<0.05).In PG1 and PG2 patients,there were no significant differences in the average age,BMI,basal antral follicle count(AFC),basal FSH,basal LH,infertility years,Gn starting doses,Gn total amount,Gn days,number of oocytes retrieved,number of mature oocytes and number of 2PN embryos between the GH group and the control group(P>0.05).In PG1 patients,the number of available Day 3 embryos[(3.07±2.89)vs.(4.84±3.55)]of GH group was significantly less than that of control group(P<0.05).In PG1 and PG2 patients,there were no significant differences in transplantation rate of fresh cycle,age at embryo transplantation,endometrial thickness on transplantation day,number of embryos transplanted,number of Day 3 transplantation cycles,embryo implantation rate,biochemical pregnancy rate and clinical pregnancy rate between GH group and control group(P>0.05).Conclusions:In PG1 and PG2 patients with unexpected poor ovarian response,pretreatment with GH before oocytes retrieval can increase the transplantation rate of fresh cycle.There is a trend of improving the biochemical pregnancy rate and clinical pregnancy rate of patients,but it is still necessary to study whether it can improve ovarian response and pregnancy outcome.