GnRH-a联合HCG双扳机对年轻患者IVF/ICSI妊娠结局的影响

Effect of GnRH-agonist combined with HCG double trigger on pregnancy outcome of IVF/ICSI in young patients

目的探究GnRH拮抗剂促排卵方案中用GnRH激动剂(GnRH-a)联合HCG双扳机是否可以改善年轻患者的IVF/ICSI妊娠结局。方法本研究为回顾性队列研究,收集2020年1月至2021年12月期间在西北妇女儿童医院采用拮抗剂方案行IVF/ICSI助孕且年龄≤35岁的患者资料,根据HCG日应用扳机药物的不同分为单扳机组(HCG扳机,n=2070)及双扳机组(GnRH-a+HCG扳机,n=453),比较两组间的基本资料、促排卵情况以及新鲜周期移植后的临床妊娠结局,并对年龄、窦卵泡计数(AFC)、体质量指数(BMI)、不孕年限、移植胚胎个数以及扳机方式等影响妊娠结局的主要因素行Logistic多因素分析。结果两组患者间年龄、BMI、不孕年限、基础FSH水平、原发不孕占比、总Gn剂量、Gn天数、HCG日激素(E 2、P及LH)水平、ICSI周期MII卵数、受精方式、可用胚胎数、优质胚胎数,以及新鲜周期的移植胚胎个数、移植囊胚占比及临床妊娠率等比较均无统计学差异(P>0.05)。与单扳机组相比,双扳机组患者流产率(22.63%vs.16.89%)显著升高,活产率(40.40%vs.47.44%)显著降低(P<0.05)。在校正了年龄、AFC、BMI、不孕年限、移植胚胎个数等相关混杂因素后,双扳机会导致新鲜周期活产率低[OR=0.746,95%CI(0.605,0.920),P=0.006];另外年龄[OR=0.966,95%CI(0.939,0.994),P=0.018]及不孕年限[OR=0.961,95%CI(0.928,0.994),P=0.022]为活产率的独立影响因素,年龄小、不孕时间短者活产率更高(P<0.05)。结论扳机方式和年龄、不孕年限均为影响年轻患者IVF/ICSI妊娠结局的主要因素。首次行IVF助孕的年轻患者,扳机日经评估无明显OHSS风险且可新鲜周期移植时,用GnRH-a联合HCG双扳机并不能改善新鲜周期的妊娠结局。

Objective:To explore whether GnRH-agonist(GnRH-a)combined with HCG double trigger can improve the IVF/ICSI pregnancy outcome of ovarian hyperstimulation(COH)with GnRH antagonist protocol in young patients.Methods:This study was a retrospective cohort study.The data of patients who were≤35 years old and received IVF/ICSI treatment with GnRH antagonist protocol were collected in Northwest Women’s&Children’s Hospital from January 2020 to December 2021.According to the difference of trigger drugs applied on HCG day,they were divided into the single trigger group(HCG trigger,n=2070)and double trigger group(GnRH-a+HCG trigger,n=453).The basic data,COH outcomes and clinical pregnancy outcomes after fresh embryo transfer were compared between two groups.Logistic multivariate analysis was performed on the main factors affecting pregnancy outcome,such as age,antral follicle count(AFC),body mass index(BMI),infertility years,number of embryos transferred and trigger mode.Results:There were no significant differences in age,BMI,duration of infertility,basic FSH levels,proportion of primary infertility,total Gn doses,Gn days,the hormone levels(E 2,P and LH)on HCG day,number of MII oocytes in ICSI cycle,fertilization method,number of available embryos and high-quality embryos,number of embryos transferred in a fresh cycle,proportion of blastocysts transferred,and clinical pregnancy rate between the two groups(P>0.05).Compared with the single trigger group,the patients in the double trigger group had significantly higher abortion rate(22.63%vs.16.89%)and significantly lower live birth rate(40.40%vs.47.44%)(P<0.05).After adjusted for confounding factors such as age,AFC,BMI,duration of infertility,and number of embryos transferred,double triggers resulted in significantly lower live birth rate in fresh embryo transfer cycles[OR=0.746,95%CI(0.605,0.920),P=0.006].In addition,age[OR=0.966,95%CI(0.939,0.994),P=0.018]and infertility duration[OR=0.961,95%CI(0.928,0.994),P=0.022]were the independent influencing factors of live birth rate,and those with younger age and shorter infertility duration had a higher living rate(P<0.05).Conclusions:Trigger mode,age and infertility years are the main factors affecting pregnancy outcome in young patients.When the young patients who received the first IVF treatment cycle have no obvious OHSS risk after evaluation on the trigger day,GnRH-a combined with HCG double trigger cannot improve the pregnancy outcome in fresh embryo transfer cycle.