两种不同来源促卵泡激素对早卵泡期长效长方案不同体重指数患者IVF/ICSI-ET临床结局的影响

Effects of two different sources of FSH on clinical outcomes of IVF/ICSI-ET for patients with different body mass indexes in early follicular phase prolonged protocol

目的:比较不同体重指数(BMI)预期卵巢正常反应患者在早卵泡期长效长方案(长长方案)体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)中应用尿促卵泡激素(uFSH)和基因重组人促卵泡激素(rFSH)临床结局的差异。方法:回顾性收集2015年9月至2019年12月在郑州大学第三附属医院生殖医学中心行长长方案IVF/ICSI-ET助孕且预期卵巢正常反应的患者,按照BMI分为偏瘦或正常组(BMI<24 kg/m2,1056例)、超重组(24 kg/m2≤BMI<28 kg/m2,554例)和肥胖组(BMI≥28 kg/m2,112例)。在3组不同BMI的患者中,分别对使用uFSH或rFSH进行超促排卵IVF/ICSI-ET助孕的两组患者以年龄、窦卵泡数、不孕年限、基础FSH和抗米勒管激素(AMH)进行1∶1倾向性评分匹配,对匹配后患者的数据进行分析。比较两组患者Gn启动量、Gn时间、Gn总量、Gn费用,HCG日内膜厚度、LH、E2、P、≥14 mm卵泡数、获卵数、可利用胚胎数以及两组患者优质胚胎率、中重度卵巢过度刺激(OHSS)综合征发生率、胚胎着床率、临床妊娠率、流产率、活产率、累积妊娠率和累积分娩率的差异。结果:3组不同BMI的患者rFSH组和uFSH组比较,获卵数、中重度OHSS发生率、临床妊娠率、活产率差异均无统计学意义(P>0.05),uFSH组的Gn启动量均高于rFSH组(P均<0.05),而Gn费用低于rFSH组(P<0.05);偏瘦或正常组和超重uFSH组的Gn总量均高于rFSH组(P<0.05);肥胖组中uFSH组的优质胚胎率(44.03%)高于rFSH组(32.10%),差异有统计学意义(P<0.001)。结论:uFSH的临床有效性不低于rFSH,控制性卵巢刺激有效性低于rFSH;uFSH成本低,更具有经济学优势;肥胖患者可能更适合选用uFSH进行超促排卵。

Aim:To compare the differences in clinical outcomes between patients with different body mass index(BMI)and expected normal ovarian response in early follicular phase prolonged protocol of IVF/ICSI-ET using urinary-derived follicle stimulating hormone(uFSH)and genetically recombinant follicle stimulating hormone(rFSH).Methods:A retrospective analysis of patients with expected normal ovarian response who underwent IVF/ICSI-ET with GnRH agonist protocols from September 2015 to December 2019 in the Reproduction Center of the Third Affiliated Hospital of Zhengzhou University.According to different BMI,all patients were divided into three groups,the group with BMI<24 kg/m2 group(n=1056);overweight group(24 kg/m2≤BMI<28 kg/m2,n=554);obese group(BMI≥28 kg/m2,n=112).Among the three groups of patients with different BMI,the patients of uFSH group and rFSH group were matched with a 1∶1 propensity score based on age,duration of infertility,and antral follicle count(AFC),basal serum FSH level,anti-Müllerian hormone(AMH).Then analysis was conducted between the matched groups to find the differences in starting dosage of Gn used,duration of Gn used,total dosage of Gn used,cost of Gn,endometrial thickness on the HCG injection day,LH level,E2 level,P level,number of≥14 mm follicles on HCG injection day,number of oocytes retrieved,number of available embryos,rate of high-quality embryos,incidence of moderate to severe OHSS,clinical pregnancy rate,embryo implantation rate,miscarriage rate,live birth rate,cumulative pregnancy rate,and cumulative delivery rate.Results:Among the three groups of patients with different BMI,there was no statistical difference in the number of oocytes retrieved,the incidence of moderate to severe OHSS,clinical pregnancy rate,or live birth rate between the rFSH group and the uFSH group(P>0.05),starting dosage of Gn used of Gn used of uFSH group was significantly larger than that of rFSH group(P<0.05),and the cost of Gn was significantly lower than that of rFSH group(P<0.05).Total dosage of Gn used of uFSH group was significantly larger than that of rFSH group in the BMI≥24 kg/m2 group and overweight group(P<0.05).In the obese group,the high-quality embryo rate in uFSH group(44.03%)was significantly higher than that in rFSH group(32.10%)(P<0.001).Conclusion:The clinical effectiveness of uFSH is similar with rFSH,but the effectiveness of controlled ovarian hyperstimulation was less than rFSH.The economic cost of uFSH was low,thus it has economic advantages.It may be more suitable for the obese patients to use uFSH for superovulation.