3种促排卵方案对子宫内膜异位症患者妊娠结局的影响

Effects of three ovulation induction programs on pregnancy outcomes in patients with endometriosis

目的分析3种促排卵方案对行体外受精-胚胎移植(IVF-ET)的子宫内膜异位症患者的促排效果及妊娠结局的影响。方法回顾性分析2016年1月至2021年4月在安徽医科大学第一附属医院生殖中心临床诊断的子宫内膜异位症共342例。按照不同的促排卵方案分为超长方案组(A组)、长方案组(B组)、拮抗剂组(C组),比较3组患者的一般情况和妊娠结局。结果3组患者的年龄、不孕年限、体质指数、基础FSH、基础E_(2)、基础LH以及降调前CA125,差异均无统计学意义(P>0.05);MII卵数、获卵数3组比较差异有统计学意义(P<0.05),A组及B组多于C组;促性腺激素(gonadotropin,Gn)总剂量、Gn用药天数差异有统计学意义(P<0.05),C组的Gn总剂量、用药天数均显著低于A组和B组;3组的囊胚数、2PN受精率和囊胚形成率差异无统计学意义(P>0.05)。其中286份临床病例参与首次冻胚移植,3组方案的种植率、临床妊娠率、流产率、活产率、继续妊娠率差异无统计学意义(P>0.05)。结论子宫内膜异位症患者接受IVF-ET治疗选择促排卵方案时,拮抗剂方案可达到同样的超排效果及妊娠结局,但用药剂量更少、用药时间更短。

Objective To analyze the effects of three ovulation induction regimens on ovulation induction and pregnancy outcomes in endometriosis patients undergoing in vitro fertilization-embryo transfer(IVF-ET).Methods A total of 342 cases of endometriosis clinically diagnosed in the Reproductive Center of the First Affiliated Hospital of Anhui Medical University from January 2016 to April 2021 were retrospectively analyzed.According to different ovulation induction regimens,they were divided into ultra-long regimen group(group A),long regimen group(group B),and antagonist group(group C).The general conditions and pregnancy outcomes of the three groups were compared.Results There were no significant differences in age,infertility years,body mass index,basal FSH,basal E_(2),basal LH and CA125 before down-regulation of the three patients(P>0.05).There were significant differences in the number of MII eggs and the number of oocytes retrieved among the three groups(P<0.05),and the number of group A and group B was more than that of group C.There were significant differences in the total dose of gonadotropin(Gn)and the number of days of Gn medication(P<0.05).However,the total dose of gonadotropin(Gn)and the number of days of medication in group C were significantly lower than those in groups A and B.There were no statistical differences in the number of blastocysts,2PN fertilization rate and blastocyst rate among the three groups(P>0.05).Among them,286 clinical cases participated in the first frozen embryo transfer.There were no significant differences in the implantation rate,clinical pregnancy rate,abortion rate,live birth rate,and continued pregnancy rate among the three groups(P>0.05).Conclusion When endometriosis patients receive IVF-ET treatment and choose ovulation induction program,antagonist regimen can achieve the same superovulation effect and pregnancy outcome,but with lower dosage and shorter medication time.