正常反应人群拮抗剂方案与激动剂长方案的临床特点及结局比较

Clinical features and outcomes of IVF-ET cycles between GnRH antagonist and GnRH agonist long protocol in normal responders:a comparison of 266 cases

目的分析比较体外授精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)治疗中采用促性腺激素释放激素(gonadotrophin releasing hormone,GnRH)拮抗剂方案(简称拮抗剂方案)或激动剂长方案(简称长方案)的正常反应人群IVF-ET周期的临床特点及结局。方法收集2017年1月至2019年3月我中心接受IVF-ET治疗采用拮抗剂或长方案的卵巢正常反应患者的临床资料,根据新鲜周期的方案及是否移植分为3组,A组:拮抗剂未移植组(128例),B组:拮抗剂移植组(138例),C组:长方案移植组(720例);同时,进一步统计拮抗剂未移植组患者第1次冷冻胚胎移植(frozen embryo transfer,FET)转化日内膜厚度及临床结局,作为D组,比较拮抗剂方案与长方案在正常反应人群中应用的临床特点及结局。结果(1)A、B组使用促性腺激素(gonadotropin,Gn)时间及用量均0.05;(4)B、C、D 3组患者生化妊娠率、临床妊娠率差异均无统计学意义,B组患者着床率最低,流产率最高,与C组间差异有统计学意义(P<0.05)。结论正常反应人群拮抗剂方案可获得与长方案相似的卵母细胞及胚胎,拮抗剂对子宫内膜容受性的负面影响可能会引起临床妊娠率低,流产率高。

Objective To analyze and compare the clinical features and outcomes of in vitro fertilization-embryo transfer(IVF-ET)cycles in normal responders using gonadotrophin(Gn)releasing hormone(GnRH)antagonist or GnRH agonist long protocol.Methods The clinical data of patients who received IVF treatment and had normal ovarian response to GnRH antagonist or GnRH agonist long protocol in our reproductive center from January 2017 to March 2019 were collected.According to the treatment protocol and the fresh embryo transplanted or not,these patients were divided into Group A(receiving GnRH antagonist,but no fresh embryo transplanted,n=128),Group B(GnRH antagonist,with fresh embryo transplanted,n=138),and Group C(GnRH agonist long protocol,with fresh embryo transplanted,n=720).Besides,the frozen embryo transfer(FET)cycles of Group A were analyzed,and served as Group D.The thickness of endometrium on luteal conversion day and outcome of Group D were compared with those of Group B and Group C.Results(1)The duration and dosage of Gn were shorter and less in Group A and B than Group C,and statistical difference was seen in Gn duration(P<0.05),and in Gn dosage only between Group A and C(P<0.05).(2)On HCG day,the serum estradiol(E2)level were lower in Group A and B than Group C(P<0.05),the endometrium of Group C was the thickest,and the thickness of endometrium on luteal conversion day of Group D was lower than that on the HCG day of Group A,B and C,where the differences between Group A and B,and Group C and D were statistically significant(P<0.05).(3)The number of oocytes obtained in Group A and B were less than that in Group C(P<0.05),but there were no statistical difference in metaphaseⅡ(MⅡ)oocyte rate,normal fertilization rate and high-quality embryo rate among Group A,B and C.(4)Biochemical pregnancy rate and clinical pregnancy rate had no statistical differences among Group B,C,and D(P<0.05).Group B had the lowest implantation rate but the highest miscarriage rate,and had obvious differences with Group C(P<0.05).Conclusion GnRH antagonist protocol can obtain similar oocytes and embryos as the GnRH-a long protocol in normal response population.However,the antagonist may exert negative impact on endometrial receptivity and result in low pregnancy rate and high abortion rate.