GnRH激动剂长方案和拮抗剂方案中HCG日孕酮与获卵数比值对后续FET周期妊娠结局的影响

Effect of ratio between progesterone level on HCG day and number of oocytes retrieved on pregnancy outcomes of subsequent FET cycles in GnRH agonist long protocol or antagonist protocol

目的探讨促排卵过程中GnRH激动剂(GnRH-a)长方案和拮抗剂方案HCG日孕酮(P)/获卵数(O)比值对后续冻融胚胎移植(FET)周期妊娠结局的影响。方法回顾性分析2017年10月至2019年12月在空军军医大学唐都医院生殖医学中心行FET助孕的2321个周期的临床资料。根据促排卵周期HCG日P/O比值不同,将研究对象分为3组:Ⅰ组(0.02≤P/O≤0.17,764个周期),Ⅱ组(0.17<P/O≤0.34,790个周期)和Ⅲ组(0.34<P/O≤2.67,767个周期)。采用单因素及多元Logistic回归分析GnRH-a长方案和拮抗剂方案HCG日P/O比值对后续FET周期临床妊娠率、流产率、异位妊娠率及持续妊娠率的影响。结果单因素分析结果显示:拮抗剂方案中随着P/O比值升高,后续FET周期的着床率、临床妊娠率及持续妊娠率均显著性下降(P<0.05),而多元Logistic回归模型矫正基线资料后,不论GnRH-a长方案还是拮抗剂方案,P/O比值对后续FET周期妊娠结局的影响均无显著性差异(P>0.05)。进一步分析两种促排卵方案中不同P/O比值亚组对妊娠结局的交互作用影响,结果显示:在拮抗剂方案的Ⅲ组中,随着P/O比值增加,后续FET周期临床妊娠率呈下降趋势[OR=0.61,95%CI(0.01,0.89),交互P=0.026],而对流产率、异位妊娠率及持续妊娠率的影响无显著差别(P>0.05)。结论在P/O比值≤0.34时,不论GnRH-a长方案还是拮抗剂方案,其后续FET周期妊娠结局均不受影响;而当P/O比值>0.34时,随着其比值增加,拮抗剂方案后续FET周期的临床妊娠率可能降低。

Objective:To investigate the effect of ratio between progesterone level on HCG day and number of oocytes retrieved(P/O)on pregnancy outcomes of subsequent frozen-thawed embryo transfer(FET)cycles in GnRH agonist(GnRH-a)long protocol or antagonist protocol.Methods:The clinical data of 2321 FET cycles in the Reproductive Medicine Center of Tang Du Hospital from October 2017 to December 2019 was retrospectively analyzed.According to the P/O ratio,the subjects were divided into three groups:groupⅠ(0.02≤P/O≤0.17,764 cycles),groupⅡ(0.17<P/O≤0.34,790 cycles)and groupⅢ(0.34<P/O≤2.67,767 cycles).Univariate and multivariate logistic regression models were used to analyze the effects of P/O ratio in GnRH-a long and antagonist protocol on the clinical pregnancy rate,abortion rate,ectopic pregnancy rate and ongoing pregnancy rate in subsequent FET cycles.Results:The result of univariate analysis showed that the implantation rate,clinical pregnancy rate and ongoing pregnancy rate of subsequent FET cycles were significantly decreased with the increase of P/O ratio in antagonist protocol(P<0.05).After adjusting for confounding factors by multiple regression model,regardless of GnRH-a long protocol or antagonist protocol,the P/O ratio had no significant effect on the pregnancy outcomes of subsequent FET cycles(P>0.05).After further analysis of interaction effect of P/O ratio on pregnancy outcomes in the different subgroups of two ovulation induction protocols,the results showed that the clinical pregnancy rate of FET cycle was decreased significantly with increase of P/O ratio in groupⅢwith antagonist protocol[OR=0.61,95%CI(0.01,0.89),P=0.026],but the effect on abortion rate,ectopic pregnancy rate and ongoing pregnancy rate were not significantly different(P>0.05).Conclusions:When P/O ratio is≤0.34,no matter GnRH-a long protocol or antagonist protocol,pregnancy outcomes of subsequent FET cycle are not affected.When P/O ratio is>0.34,clinical pregnancy rate in subsequent FET cycle decreases with the increase of ratio in antagonist protocol.