早卵泡期长效长方案最佳获卵数的探讨

Investigate the optimal number of oocytes retrieved of early follicular phase prolonged protocol

目的探讨早卵泡期长效长方案的最佳获卵数及在达到较高累积活产率(cumulative live birth rate,CLBR)的同时,减少卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)的风险。方法回顾性队列研究分析2014年1月至2017年12月期间在郑州大学第三附属医院生殖医学科首次行体外受精或卵胞质内单精子注射助孕且采用早卵泡期长效长方案的患者作为研究对象。根据获卵数进行分组,A组:获卵数1~5枚;B组:获卵数6~10枚;C组:获卵数11~15枚;D组:获卵数16~20枚;E组:获卵数>20枚,分析5组患者的基础资料及临床数据。主要观察指标为CLBR和OHSS发生率。采用二元逻辑回归校正混杂因素,分析影响CLBR和OHSS发生率的因素。结果女方年龄的增加(aOR=0.93,95%CI=0.90~0.97,P<0.001)和体质量指数的增加(aOR=0.95,95%CI=0.92~0.99,P=0.02)是CLBR的危险因素,获卵数的增加(aOR=1.27,95%CI=1.20~1.35,P<0.001)是CLBR的保护因素。女方年龄越小(aOR=0.94,95%CI=0.91~0.97,P<0.001)、体质量指数减低(aOR=0.96,95%CI=0.93~0.99,P=0.04)、获卵数增加(aOR=1.84,95%CI=1.64~2.06,P<0.001)是OHSS发生率的危险因素。随着获卵数的增加(A组到C组),CLBR增长显著,差异有统计学意义[51.6%(157/304)、64.8%(869/1314)、75.2%(1334/1774),P<0.001],而C组、D组和E组间CLBR的差异无统计学意义(P>0.05)。随着获卵数增加(A组到E组),OHSS发生率增加显著,差异有统计学意义[0.3%(1/304)、3.3%(44/1314)、5.0%(88/1774)、9.8%(104/1065)、15.4%(77/499),P<0.001],尤其是在获卵数>15枚时,OHSS发生率明显增加。结论早卵泡期长效长方案中,获卵数在11~15枚,可获得较高的CLBR,且OHSS发生率较低,为适宜的获卵数区间。

Objective To investigate the optimal number of oocytes retrieved of early follicular phase prolonged protocol and to reduce the risk of ovarian hyperstimulation syndrome(OHSS)while achieving a high cumulative live birth rate(CLBR).Methods It was a retrospective cohort study.Patients who underwent the first in vitro fertilization or intracytoplasmic sperm injection in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2014 to December 2017 were included.According to the number of oocytes retrieved,we divided all patients into 5 groups,group A:1-5 oocytes,group B:6-10 oocytes,group C:11-15 oocytes,group D:15-20 oocytes,group E:>20 oocytes.The basic and clinical data of 5 groups were analyzed.The main outcome measures were CLBR and the incidence of OHSS.Binary logistic regression was used to correct confounding factors to analyze the factors affecting the CLBR and the incidence of OHSS.We calculated the CLBR and the incidence of OHSS in each group.Results The maternal age(aOR=0.93,95%CI=0.90-0.97,P<0.001)and body mass index(aOR=0.95,95%CI=0.92-0.99,P=0.02)were risk factors for CLBR.The number of oocytes retrieved was the protection factor for CLBR(aOR=1.27,95%CI=1.20-1.35,P<0.001).The maternal age(aOR=0.94,95%CI=0.91-0.97,P<0.001),body mass index(aOR=0.96,95%CI=0.93-0.99,P=0.04),and increase in the number of oocytes retrieved(aOR=1.84,95%CI=1.64-2.06,P<0.001)were the independent risk factors of the incidence of OHSS.With the increase of the number of oocytes retrieved(group A to group C),CLBR increased significantly[51.6%(157/304),64.8%(869/1314),75.2%(1334/1774),P<0.001],while the differences among groups C,D and E were not statistically significant(P>0.05).With the increase in the number of oocytes retrieved(group A to group E),the incidence of OHSS increased significantly[0.3%(1/304),3.3%(44/1314),5.0%(88/1774),9.8%(104/1065),15.4%(77/499),P<0.001],especially when the number of oocytes retrieved was>15.Conclusion For the early follicular phase prolonged protocol,the optimal number of oocytes retrieved is 11-15,which can obtain higher CLBR,and reduce the incidence of OHSS.