促性腺激素释放激素激动剂联合小剂量人绒毛膜促性腺激素双扳机在卵巢高反应患者拮抗剂促排卵周期中的应用效果

Effect of gonadotropin-releasing hormone agonist combined with low dose human chorionic gonadotropin double trigger on ovulation induction cycle of antagonist in patients with high ovarian response

目的探讨促性腺激素释放激素激动剂(GnRH-a)联合小剂量人绒毛膜促性腺激素(HCG)双扳机在卵巢高反应患者拮抗剂促排卵周期中的应用效果。方法选取2016年4月至2020年1月浙江省台州医院行体外受精-胚胎移植(IVF-ET)治疗的189例促排卵高反应患者作为研究对象。其中120例采用GnRH-a联合小剂量HCG双扳机治疗的纳入A组,69例采用常规HCG扳机治疗的纳入B组。比较两组控制性促排卵周期结局、第一次解冻周期情况及妊娠结局。结果 A、B组中重度卵巢过度刺激综合征(OHSS)发生率(5.83%vs.15.94%)比较,差异具有统计学意义(P<0.05);A、B组各97例、53例患者进行冻融胚胎移植,冻融胚胎移植周期中,A、B组临床妊娠率(60.67%vs.54.35%)、流产率(6.74%vs.10.87%)、活产率(50.56%vs.45.65%)比较,差异无统计学意义(P>0.05)。结论卵巢高反应患者拮抗剂促排卵周期中,GnRH-a联合小剂量HCG双扳机治疗,可降低OHSS发生及程度,增加促排卵的安全性,而且不影响冻融胚胎移植妊娠结局。

Objective To investigate the effect of gonadotropin-releasing hormone agonist combined with low dose human chorionic gonadotropin double trigger on ovulation induction cycle of antagonist in patients with high ovarian response. Methods 189 ovulation induction hyperresponsive patients who received IVF-ET treatment in Taizhou Hospital from April 2016 to January 2020 were selected as the research subjects. Among them, 120 patients treated with GnRH-a combined with low-dose HCG double trigger were included in group A, and 69 patients treated with conventional HCG trigger were included in group B. The outcome of controlled ovulation induction cycle, the first thawing cycle and pregnancy outcome were compared between the two groups. Results The incidence of moderate and severe ovarian hyperstimulation syndrome(OHSS) was compared between group A and B(5.83% vs.15.94%), and the difference was statistically significant(P<0.05). 97 patients and 53 patients in group A and B received freeze-thaw embryo transfer, respectively. During the freeze-thaw embryo transfer cycle, the clinical pregnancy rate(60.67% vs.54.35%), abortion rate(6.74% vs.10.87%) and live birth rate(50.56% vs. 45.65%) in group A and B were compared. The difference was not statistically significant(P>0.05). Conclusions In the ovulation induction cycle of the antagonist for patients with high ovarian response, GnRH-a combined with low-dose HCG double trigger treatment can reduce the occurrence and degree of OHSS, increase the safety of ovulation induction, and do not affect the pregnancy outcome of freeze-thaw embryo transfer.