生长激素联合GnRHa短效长方案在POSEION 2型患者IVF/ICSI中应用效果评价

Evaluation of growth hormone combined with short-acting GnRha long protocol in POSEION 2 patients with IVF/ICSI

目的探讨生长激素联合促性腺激素释放激素激动剂(GnRHa)短效长方案在波塞冬(POSEION)2型患者体外受精/单精子卵胞浆内显微注射(IVF/ICSI)周期应用效果。方法回顾性分析2020年1月至2021年9月在新疆医科大学学第一附属医院采用GnRHa短效长方案助孕治疗的183例POSEION 2型患者的临床资料,按照是否添加生长激素及生长激素添加时机分为3组:降调日开始添加生长激素组(A组)68例、Gn启动日添加生长激素组(B组)60例、未添加生长激素组(C组)55例,比较3组患者一般资料、促排卵周期情况、实验室及临床结局。结果3组患者年龄、不孕时间、体质指数(BMI)和基础促卵泡生生素(bFSH)、抗苗勒氏管激素(AMH)均无统计学差异。3组患者促排卵过程相关参数方面比较,C组平均促性腺激素(Gn)时间及平均Gn总量均高于A、B两组,组间差异有统计学意义(P<0.05);启动量A组低于B组及C组,A、B两组人绒毛膜促性腺激素(HCG)日≥14 mm卵泡数、HCG日雌二醇(E2)水平及HCG日内膜厚度均高于C组,组间差异无统计学意义(P>0.05)。3组患者实验室及临床结局参数比较,A组第二次减数分裂中期(MII)卵数、双原核(2PN)数、第3天(D3)可用胚胎数、D3优质胚胎数及鲜胚移植临床妊娠率均明显高于B、C两组,移植取消率A组明显低于B、C两组,组间差异有统计学意义(P<0.05),A组获卵数高于B、C两组,但组间差异无统计学意义(P>0.05)。结论对于POSEION 2型患者,GnRHa短效长方案可作为常规促排卵方案,于该方案降调日开始生长激素预处理可获得较好的临床及实验室结局。对于未能提前生长激素预处理患者,于Gn启动开始添加生长激素可减少Gn时间和Gn总量。因此对POSEION 2型患者可给予生长激素,生长激素添加时机在促超排卵前至少3周可能更为合理。

Objective To explore the effects of growth hormone(GH)combined with short-acting GnRha long-term protocol on Poseion 2 patients.Methods The datas of 183 casess with Poseidon tipe2 treated with short-acting long protocol in our hospital from January 2020 to September 2021 were reviewed,They were divided into three groups according to the addition of growth hormone and reagent:Start adding GH on the down-regulation day(Group A)68 casess,and on the Gn initiation day(Group B)60casess,no adding GH(Group C)55 casess.The general data,Parameters related to ovulation induction process,laboratory and clinical outcomes of the 3 groups were compared.Results In general data,the two groups of patients′age,infertility time,BMI and basic FSH,AMH were not statistically different;in the aspect of parameters related to ovulation induction,the mean time of Gn and the mean total dose of Gn in Group C were higher than those in Group A and Group B,there were statistically significant(P<0.05).And initiation dose of Gn in Group A was lower than that in Group B and Group C,but the number of follicles≥14 mm,the level of E2 and the endometrial thickness on HCG day in Group A and group B were higher than those in Group C,the difference between groups was not statistically different(P>0.05);in the aspect of parameters related to laboratory and clinical outcomes,the number of MII oocytes,2PN,available D3 embryos,high-quality D3 embryos and the clinical pregnancy rate of fresh embryo transfer in Group A were significantly higher than those in Group B and C,and the cycle cancellation rate in Group A was significantly lower than that in Group B and C,there were statistically significant(P<0.05).In addition,the retrieved oocytes′number in Group A was higher than that in Group B and Group C,but there was no significant difference between the groups(P>0.05).Conclusion The short-acting GnRha long protocol can be used as a routine ovulation induction program for patients with Poseion type2,a better clinical and laboratory outcome can be obtained by the beginning of the GH pretreatment on the down-regulation day,for those who can not be pretreated with GH,adding GH on the Gn initiation day can reduce the Gn time and the total dose of Gn,so Poseion type2 patients can be given GH,the timing of GH supplementation may be more reasonable at least 3 weeks prior to ovulation induction.