卵泡期长效长方案与拮抗剂方案在卵巢正常反应人群中临床效果比较

Comparison of Clinical Effects between the Long GnRH Agonist Protocols during Early Follicular Phase and the Antagonist Protocols in Normal Responders

目的:比较卵泡期长效长方案与拮抗剂方案在卵巢正常反应人群中促排卵结局。方法:回顾性分析2018年1月至2020年12月在十堰市太和医院生殖医学中心行体外受精(in vitro fertilization,IVF)/卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)的卵巢正常反应患者的病例资料。按促排卵方案分为卵泡期长效长方案组与拮抗剂组,对患者的一般情况、超促排卵临床及实验室指标、体外受精胚胎发育情况及妊娠结局进行对比分析。结果:⑴长方案组的促性腺激素(gonadotrophin,Gn)使用剂量、Gn天数、HCG日A型子宫内膜占比均大于拮抗剂组(P<0.05)。⑵长方案组HCG日血黄体生成素(luteinizing hormone,LH)水平低于拮抗剂组,HCG日直径大于14 mm卵泡数、获卵数、成熟卵数、囊胚形成率、优质囊胚形成率大于拮抗剂组(P<0.05),两组的D3可利用胚胎数、D3优胚率无差异(P>0.05)。⑶长方案组的新鲜周期取消移植率低于拮抗剂组,胚胎种植率、临床妊娠率高于拮抗剂组(P<0.05),两组流产率、早产率无差异(P>0.05)。结论:对于正常反应人群患者而言,选择卵泡期长效长方案获益更高。

Objective To compare the outcome of the long GnRH agonist protocols during early follicular phase and the an⁃tagonist protocols in normal responders.Methods The clinical data of patients with normal ovarian response who underwent in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)in Reproductive Medicine Center of Taihe Hospital,Shiyan city from January 2018 to December 2020 were retrospectively analyzed.According to the controlled ovarian hypers⁃timulation protocol,the patients were divided into two groups:the long GnRH agonist protocols during early follicular phase group and the antagonist protocols group.The general condition of the patient,clinical and laboratory indicators of hyper⁃ovulation stimulation,in vitro fertilization embryo development and pregnancy outcome of the patients were compared and analyzed.Results⑴Gonadotrophin(Gn)dose,Gn days,and the proportion of type A endometrium on HCG injection day in the long-acting agonist group were all higher than those in the antagonist group(P<0.05).⑵On the injection day of HCG,the plasma luteinizing hormone(LH)level in the long-acting agonist group was lower than that in the antagonist group,and the number of follicles with a diameter of more than 14 mm was higher than that in the antagonist group(P<0􀆰05).The number of obtained eggs,mature eggs,blastocyst formation rate and high quality blastocyst production rate in long-acting agonist group were higher than those in antagonist group(P<0􀆰05).There were no differences in the number of D3 available embryos and the rate of D3 good quality embryos between the two groups(P>0.05).⑶The cancellation rate of fresh cycle in the long-acting agonist group was lower than that in the antagonist group,and the embryo implantation rate and clinical pregnancy rate were higher than those in the antagonist group(P<0.05).There were no differences in pregnan⁃cy rate,biochemical pregnancy rate,abortion rate and premature birth rate between the two groups(P>0.05).Conclusion For patients with normal responses,using the long GnRH agonist protocols during early follicular phase is more beneficial.