拮抗剂方案与短效长方案在卵巢正常反应人群IVF-ET中的应用比较

Comparison of GnRH-A protocol and follicular phase long protocol in patients with normal ovarian response during IVF-ET

目的:比较体外受精-胚胎移植(IVF-ET)中拮抗剂方案与短效长方案的治疗结局。方法:回顾性分析2017年1月至2017年12月在河北省沧州中西医结合医院接受体外受精-胚胎移植(IVF-ET)治疗的卵巢正常反应不孕患者,共437例,将其分为拮抗剂方案组(146例)及短效长方案组(291例)。结果:拮抗剂方案组Gn使用天数(9.71±1.72)d明显短于短效长方案组Gn使用天数(11.59±2.20)d(P<0.05);拮抗剂方案组的Gn平均使用量(2614.00±900.85)IU明显比短效长方案组Gn平均使用量(3041.00±1017.00)IU少(P<0.05);拮抗剂方案组的获卵数(7.51±3.98)个少于短效长方案组的获卵数(10.65±5.26)个,且差异有统计学意义(P<0.05);拮抗剂方案获得优质胚胎数与短效长方案组相比,差异无统计学意义(P>0.05);拮抗剂方案组生化妊娠率(7.52%)及临床妊娠率(44.33%)比短效长方案组生化妊娠率(26.71%)及临床妊娠率(42.96%)低(P<0.05),但两组患者活产率无明显差异(P>0.05);拮抗剂方案组流产率(3.42%)及卵巢过度刺激发生率(0.00%)明显低于短效长方案组流产率(5.15%)及卵巢过度刺激发生率(3.09%)(P<0.05)。结论:拮抗剂方案可明显缩短治疗周期,减少患者因药物肌肉注射带来的痛苦,也大大降低了患者卵巢过度刺激的风险。从临床结局及费效比方面综合考虑,拮抗剂方案是比较理想的COH方案,尤其是对于农乡等收入较低患者更是一种理想的促排方案。

Objective:To compare the treatment outcomes of GnRH antagonist(GnRH-A)protocol and follicular phase long protocol in vitro fertilization-embryo transfer(IVF-ET).Methods:A retrospective analysis was made on infertility patients with normal ovarian response who received in vitro fertilization and embryo transfer(IVF-ET)in our hospital from January 2017 to December 2017.There were 437 cases,including 146 in GnRH-A protocol and 291 in follicular phase long protocol group.Results:The days of Gn use in the GnRH-A protocol group were significantly shorter than those in the follicular phase long protocol group(P<0.05).The average dose of Gn in the GnRH-A protocol group was significantly lower than that in the follicular phase long protocol group(P<0.05).The the number of eggs obtained in the GnRH-A protocol group was significantly lower than that in the follicular phase long protocol group(P<0.05).There was no significant difference in the number of high-quality embryos and the number of transplantable embryos between the two groups(P>0.05).The biochemical pregnancy rate(7.52%)and clinical pregnancy rate(44.33%)in the antagonist regimen group were lower than those(26.71%;42.96%)in the follicular phase long-term regimen group(P<0.05).But there was no significant difference in live birth rate(P>0.05).The abortion rate of the antagonist regimen(3.42%)was significantly lower than that of the follicular phase group(5.15%)(P<0.05),the incidence of ovarian hyperstimulation is the same as the abortion rate.Conclusion:The antagonist regimen significantly shortens the treatment cycle,reduces the pain of the patient's intramuscular injection,and greatly reduces the risk of ovarian hyperstimulation.Antagonist regimen is an ideal COH regimen in terms of clinical outcomes and cost-effectiveness ratio.Especially for low-income patients such as rural areas,it is an ideal promotion program.