生长激素预处理在前次IVF/ICSI失败非DOR患者中的临床应用

Clinical Application of Growth Hormone Supplementation in Non-DOR Patients with Previous IVF/ICSI Failure

目的:探讨生长激素(growth hormone,GH)预处理对前次体外受精(in vitro fertilization,IVF)/卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)失败的非卵巢储备功能减退(diminished ovarian reserve,DOR)不孕症患者临床结局的影响。方法:采用回顾性、自身前后对照研究分析174例2018年1月1日—2021年12月31日因前次IVF/ICSI失败(对照组)后于南京医科大学第一附属医院生殖医学中心行第二周期IVF/ICSI前行GH预处理治疗(GH组)的非DOR不孕症患者这2个周期的临床结局情况。结果:GH组Gn每日用量、获卵数、2PN卵裂率、优质胚胎率、胚胎种植率、临床妊娠率均高于自身对照组,促性腺激素(gonadotropin,Gn)使用时间低于自身对照组,差异有统计学意义(P<0.05),且临床妊娠率不受控制性促排卵方案的影响。2组Gn总量、移植日子宫内膜厚度、受精率、流产率比较,差异无统计学意义(均P>0.05)。GH组按照年龄分组结果显示,<35岁组的窦卵泡计数(antral follicle count,AFC)、临床妊娠率、活产率高于≥35岁组(均P<0.05),2组的体质量指数(body mass index,BMI)、抗苗勒管激素(anti-mullerian hormone,AMH)、基础卵泡刺激素(follicle stimulating hormone,FSH)、Gn使用时间、Gn总量、移植日子宫内膜厚度、获卵数、受精率、2PN卵裂率、优质胚胎率、胚胎种植率、流产率比较,差异均无统计学意义(均P>0.05)。结论:GH预处理可以提高前次IVF/ICSI失败、非DOR不孕症患者的卵巢功能及反应性,改善临床结局,尤其是年轻患者。

Objective:To investigate the effect of growth hormone(GH)supplementation on the clinical outcomes in non-diminished ovarian reserve(DOR)patients with previous in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)failure.Methods:It was a retrospective,self-controlled study.The clinical outcomes of the first and second IVF/ICSI cycle in 174 non-DOR patients undergoing the second IVF/ICSI cycle with GH supplement,from January 1st,2018 to December 31st,2021 in our center,were analyzed.Results:The gonadotropin(Gn)dosage per day,number of oocytes retrieved,2PN cleavage rate,high-quality embryo rate,embryo implantation rate and clinical pregnancy rate were significantly increased,and Gn duration were significantly decreased in the GH group compared with control group(P<0.05).The clinical pregnancy rate was not affected by the ovarian stimulation protocol,while the differences of Gn dosage,endometrial thickness,fertilization rate and abortion rate were not statistically significant(all P>0.05).Subgroup analysis indicated that the antral follicle count(AFC),clinical pregnancy rate and live birth rate in the<35 years group were higher than those in the≥35 years group(all P<0.05),while there were no significant differences in body mass index(BMI),anti-mullerian hormone(AMH),basic follicle stimulating hormone(FSH),Gn duration and dosage,endometrial thickness on the day of embryo transfer,number of oocytes retrieved,fertilization rate,2PN cleavage rate,high-quality embryo rate,embryo implantation rate and abortion rate between the two groups(all P>0.05).Conclusions:GH supplementation can improve the ovarian function and response,and clinical outcome for those non-DOR patients with previous IVF/ICSI failure,especially for young patients.