不同扳机方案对卵巢储备功能减退患者胚胎质量的影响

The influence of different trigger schemes on the embryo quality of patients with decrease ovarian reserve

目的:探讨促性腺激素释放激素激动剂(GnRH-a)扳机、人绒毛膜促性腺激素(HCG)以及两者联合双扳机方案对卵巢储备功能减退(DOR)患者的胚胎质量的影响。方法:回顾分析山东大学齐鲁医院生殖医学中心2014年1月至2020年12月应用氯米芬方案进行控制性促排卵(COH)的2399例DOR患者的临床资料,比较使用不同扳机方案(HCG、GnRH-a、GnRH-a+HCG)的胚胎实验室结局,并且根据扳机日不同优势卵泡数,比较扳机方式对胚胎实验室指标的影响。结果:双扳机组的优质胚胎率、囊胚形成率高于HCG和GnRH-a扳机组,差异有统计学意义(P<0.05),组间卵子成熟率、受精率比较,差异无统计学意义。双扳机组在扳机日卵泡直径>14mm的优势卵泡数≤2时优质胚胎率显著高于HCG和GnRH-a扳机组(P<0.05),当扳机日优势卵泡数≥5个时,3组间差距逐渐减小且差异无统计学意义。结论:GnRH-a联合小剂量HCG双扳机方案能提高应用氯米芬方案的DOR患者的优质胚胎率和囊胚形成率,尤其在扳机日卵泡直径>14mm的卵泡数为1~2个时推荐优先应用双扳机方案。

Objective:To investigate the effects of trigger schemes of gonadotropin releasing hormone agonist(GnRH-a),human chorionic gonadotropin(HCG),and GnRH-a combined with HCG on the embryo quality of patients with decrease ovarian reserve(DOR).Methods:The clinical data of 2399 DOR patients who used clomiphene regimen for controlled ovarian hyperstimulation(COH)from January 2014 to December 2020 in the Reproductive Medicine Center of Qilu Hospital of Shandong University were retrospectively analyzed.The quality of embryos from different trigger regimens were compared and the influence on different laboratory indices were compared according to the number of different dominant follicles on the trigger day.Results:The rates of high-quality embryos and blastocyst formation in the combined trigger group were higher than that in the HCG and GnRH-a trigger groups(P<0.05),though there was no statistical difference in the oocyte maturation rate and fertilization rate between those groups.The rate of high-quality embryos was significantly higher in the combined trigger group than that in the HCG and GnRH-a trigger sets(P<0.05)when the number of dominant follicles whose diameter>14mm on the trigger day were less than or equal to 2.When the number of dominant follicles on the trigger day were more than or equal to 5,the gap between the three groups gradually decreases and the difference was not statistically significant.Conclusion:GnRH-a combined with low-dose HCG trigger regimen can improve the high-quality embryo rate and blastocyst formation rate of DOR patients who use clomiphene regimen.Especially when the number of follicles with a diameter of more than 14 mm on the trigger day is 1~2,the combined trigger scheme was recommend.