促性腺激素释放激素长方案和拮抗剂方案促排卵冻融胚胎移植周期结局的比较

Comparison of Outcomes of Frozen-Thawed Embryo Transfer after GnRH-Agonist Long Protocol and GnRH-Antagonist Protocol

目的:探讨使用促性腺激素释放激素(gonadotropin-releasing hormone,GnRH)激动剂长方案和GnRH拮抗剂方案促排卵后,冻融胚胎移植(frozen-thawed embryo transfer,FET)周期的妊娠结局和新生儿结局。方法:回顾性分析2016年1月—2020年8月在南京市妇幼保健院生殖医学中心行FET的10743个周期的临床资料,其中GnRH拮抗剂方案组8304个周期,GnRH激动剂长方案组2439个周期,比较2组患者的一般资料、促排卵情况、FET情况和结局。结果:2组患者的年龄、体质量指数(body mass index,BMI)、基础卵泡刺激素(follicle stimulation hormone,FSH)水平、不孕时间、不孕类型、产次、内膜准备方案、移植胚胎数和移植胚胎类型比较,差异无统计学意义(均P>0.05)。GnRH激动剂长方案组的促性腺激素(gonadotropins,Gn)使用总量、Gn使用时间、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)扳机日雌二醇(estradiol,E_(2))水平、获卵数和卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)发生率高于GnRH拮抗剂组(均P<0.05)。2组患者的胚胎种植率、临床妊娠率、早期流产率、活产率、单双胎分娩孕周和出生体质量比较,差异无统计学意义(均P>0.05)。结论:在除外不同方案选择、鲜胚移植等因素后,GnRH激动剂长方案和GnRH拮抗剂方案的FET周期的临床结局相似;而GnRH拮抗剂方案的安全性相对较好。

Objective:To compare the clinical outcomes of frozen-thawed embryo transfer(FET)after GnRH-agonist long protocol and GnRH-antagonist protocol.Methods:The clinical data of 10743 cycles of FET in our center from January 2016 to August 2020 were analyzed retrospectively,including GnRH-antagonist protocol(n=8304)and GnRH-agonist long protocol(n=2439).The general information,clinical and neonatal outcomes were compared between the two groups.Results:There were no significant differences in the age,body mass index(BMI),basic FSH level,duration of infertility,type of infertility,parity,endometrial preparation protocol,number of embryos transferred and type of embryos transferred between the two groups(all P>0.05).The dosage of gonadotropin(Gn)used,duration of Gn used,estradiol(E_(2))level on hCG day,number of oocytes retrieved and incidence of ovarian hyperstimulation syndrome(OHSS)in the GnRH-agonist long protocol group were significantly higher than those in the antagonist group(all P<0.05).There was no significant difference in the embryo implantation rate,clinical pregnancy rate,early pregnancy loss rate,live birth rate,gestational age and birth weight of singletons and twins between the two groups(all P>0.05).Conclusions:After excluding two factors of the selection of different protocols and the fresh embryo transfer,there was no significant difference in the cycle outcomes of FET between the GnRH-agonist long protocol and GnRH-antagonist protocol while the safety of the GnRH-antagonist protocol was relatively higher.