高龄女性促排卵长方案与拮抗剂方案临床分析

Clinical analysis of long-term protocol and antagonist ovulation induction protocol in aged women

目的分析高龄女性体外受精-胚胎移植(IVF-ET)助孕治疗中两种促排卵方案(长方案与拮抗剂方案)的临床结局。方法回顾性分析郑州大学第三附属医院2016年3月至2018年3月收治的年龄≥35周岁、采用两种不同促排卵方案行体IVF-ET/体外单精子胞内注射-胚胎移植(ICSI-ET)助孕的2515个周期患者,分为长方案组(1545周期)与拮抗剂方案组(970周期)。结合两组患者的年龄、不孕年限、月经周期天数、体质指数(BMI)、基础内分泌水平、抗苗勒管激素(AMH)、基础窦卵泡数(AFC)等相关指标,比较两组患者促性腺激素(Gn)天数、Gn用量、获卵数、受精率、可移植胚胎数、子宫内膜厚度、周期取消率、妊娠率、卵巢过度刺激综合征(OHSS)发生率和流产率等结局相关指标。结果(1)在不同促排卵方案中不孕年限、月经周期天数、BMI、基础内分泌水平、AMH、AFC均差异无统计学意义(P>0.05);(2)拮抗剂方案组患者治疗中Gn使用量及使用时间,统计均低于长方案患者,差异有统计学意义(P<0.001);(3)两组在获卵数、受精率、流产率、有效胚胎数、子宫内膜厚度差异无统计学意义(P>0.05);统计拮抗剂方案组患者OHSS发生率明显低于长方案组患者,而有效胚胎数、妊娠率高于长方案组,差异有统计学意义(P<0.05)。结论拮抗剂方案促排卵在高龄女性IVF助孕治疗中,可明显降低Gn用量和Gn使用时间的前提下获得更多可移植有效胚胎,提高妊娠率降低OHSS发生率,在条件相当的前提下,为高龄患者推荐选择的促排卵方案。

Objective To analyze the clinical outcomes of 2 ovulation induction protocols(long protocol versus antagonist protocol)in assisted pregnancy treatment by in vitro fertilization embryo transfer(IVF-ET)in women of advanced age.Methods We retrospectively reviewed patients aged≥35 years admitted to the Third Affiliated Hospital of Zhengzhou University from 2016 to 2018.A total of 2515 cycles of in vitro fertilization embryo transfer(IVF-ET)/in vitro single sperm intracellular injection embryo transfer(ICSI-ET)assisted pregnancy were randomly divided into a long protocol group(1545 cycles)versus an antagonist protocol group(970 cycles).The related indicators,including age,years of infertility,number of menstrual cycle days,body mass index(BMI),basal endocrine level,anti-Müllerian hormone(AMH),and basal antral follicle number(AFC)were compared between the 2 groups;so were the gonadotropin(GN)days,GN use,number of oocytes retrieved,fertilization rate,number of transferable embryos,endometrial thickness,cycle cancellation rate,pregnancy rate,and outcome related indicators such as OHSS incidence and miscarriage rate.Results There was no significant difference in the number of infertility years,menstrual cycle days,menstrual cycle days,body mass index(BMI),basal endocrine levels,anti-Müllerian hormone(AMH),or basal antral follicle count(AFC)between the different ovulation induction regimens(P>0.05).Patients in the antagonist protocol group had significantly lower on treatment GN use and days of use than patients with the long protocol(P<0.001).There was no statistically significant difference between the two groups in the number of oocytes retrieved,fertilization rate,miscarriage rate,effective embryo number,or endometrial thickness(P>0.05).The OHSS rate of patients in the antagonist protocol group was significantly lower than that of patients with the long protocol;while the effective embryo number and pregnancy rate were higher than those of patients with the long protocol(P<0.05).Conclusion Antagonist protocol ovulation induction in IVF assisted pregnancy treatment for advanced age women can reduce the dosage of GN and the number of GN days under the premise of obtaining more transplantable effective embryos,improve the pregnancy rate and reduce the incidence of OHSS.Under the comparable conditions,the ovulation induction protocol is recommended for advanced age patients.