GnRH拮抗剂方案新鲜移植周期临床妊娠结局的影响因素分析

Analysis of Affecting Factors on Clinical Pregnancy Outcomes in GnRH Antagonist Protocol

目的:探讨影响促性腺激素释放激素(gonadotropin releasing hormone,GnRH)拮抗剂方案临床妊娠结局的相关因素。方法:回顾性分析2017年1月—2022年3月于安徽省妇幼保健院生殖医学中心采用Gn RH拮抗剂方案行体外受精/卵细胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)新鲜胚胎移植的262个治疗周期的临床资料,根据是否获得临床妊娠将其分为妊娠组与未妊娠组。采用Logistic回归分析及受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析影响临床妊娠结局的相关因素,并计算最佳截断值。结果:人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)日子宫内膜厚度是临床妊娠结局的保护因素(OR=1.421,P<0.001),子宫内膜厚度的最佳截断值为11 mm,其ROC曲线下面积为0.702;x<9 mm组种植率最低;11 mm<x<15 mm组的临床妊娠率显著高于x<9 mm组和9 mm≤x≤11 mm组(均P<0.05),但与15 mm≤x<20 mm组比较差异无统计学意义(P>0.05);各组流产率比较差异无统计学意义(P>0.05);hCG日A型内膜较B/C型内膜有更好的临床妊娠结局(OR=3.425,P=0.006)。结论:hCG日子宫内膜厚度大于11 mm的A型子宫内膜是GnRH拮抗剂方案新鲜周期临床妊娠结局的保护因素。hCG日子宫内膜过厚或过薄都应引起关注。

Objective: To investigate the factors influencing the clinical pregnancy outcomes of gonadotropin releasing hormone(GnRH) antagonist protocol. Methods:Data of 262 treatment cycles undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET) in GnRH antagonist protocol at the Reproductive Medicine Center of Anhui Provincial Maternal and Child Health Hospital from January 2017 to March 2022 were retrospectively analyzed. According to clinical pregnancy outcomes, they were assigned to the clincial pregnant group and the non-pregnant group. Multiple logistic regression analysis and the receiver operating characteristic curve(ROC) were used to analyze the risk factors affecting clinical pregnancy outcomes, and the cut-off values were calculated. Results:The thickness of endometrium on the hCG trigger day was a protection factor affecting clinical pregnancy outcomes(OR=1.421, P<0.001). The cut-off value of endometrial thickness was11 mm, and the area under the curve analysis of endometrial thickness was 0.702. Too thin endometrial thickness(<9 mm) was companied by the lowest implant rate. The clinical pregnancy rate in the 11 mm0.05). There was no significant difference in the miscarriage rate among these groups(P>0.05). The type of A endometrium on the hCG trigger day had better clinical pregnancy outcomes than the type B/C(OR=3.425, P=0.006). Conclusions:Endometrial thickness >11 mm and the Type A on the h CG trigger day were two protection factors affecting clinical pregnancy outcomes in GnRH antagonist protocol.The excessively thickened or thin endometrial thickness on the hCG trigger day should attract our attention.