FSH联合hCG双扳机对IVF-ET临床结局的影响

Effects of oocyte maturation trigger using follicle-stimulating hormone plus human chorionic gonadotropin on clinical outcomes of in vitro fertilization and embryo transfer

目的研究短效长方案促排卵患者使用卵泡刺激素(follicle-stimulating hormone,FSH)联合人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)扳机诱发排卵对体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)结局的影响。方法回顾性队列研究分析2016年2月至2017年4月期间在厦门大学附属妇女儿童医院生殖医学科行IVF/ICSI-ET助孕的682例短效长方案促排卵患者的临床资料,根据扳机方式分为重组hCG(recombinant hCG,r-hCG)组(单纯使用250μg r-hCG)439例和双扳机组[300 U尿源性FSH(urinary FSH,uFSH)联合250μg r-hCG]243例。主要观察指标为临床妊娠率与活产率,次要观察指标为优质胚胎率、胚胎植入率、生化妊娠率、流产率等。结果患者的年龄、不孕年限、体质量指数(body mass index,BMI)、抗苗勒管激素(anti-Müllerian hormone,AMH)、促性腺激素(gonadotropin,Gn)使用总量、Gn使用时间和移植胚胎数组间比较,差异均无统计学意义(均P>0.05);双扳机组胚胎种植率[40.47%(191/472)]及生化妊娠率[64.20%(156/243)]显著高于r-hCG组[32.42%(272/893),P=0.003;55.35%(243/439),P=0.025],但两组受精率、卵裂率、胚胎形成率、优质胚胎率、流产率、临床妊娠率、活产率比较差异均无统计学意义(均P>0.05)。结论短效长方案促排卵使用300 U uFSH联合250μg r-hCG双扳机并不能显著提高短效长方案IVF/ICSI-ET的临床妊娠率及活产率,但可显著提高胚胎种植率及生化妊娠率。

Objective To investigate the effects of oocyte maturation trigger using follicle-stimulating hormone(FSH)plus human chorionic gonadotropin(hCG)on clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in gonadotropin-releasing hormone agonist(GnRH-a)cycles.Methods The retrospective cohort study included 682 patients aged up to 40 years with normal ovarian response who underwent IVF/ICSI-ET at Department of Reproductive Medicine,Women and Children's Hospital,Xiamen University School of Medicine between Feburary 2016 and April 2017.Patients were grouped by whether oocyte maturation was triggered with 250μg recombinant hCG(r-hCG)plus 300 U urinary FSH(uFSH,dual trigger group,n=439)or 250μg r-hCG alone(r-hCG group,n=243).The main observation indexes were the clinical pregnancy rate and the live birth rate,and the secondary observation indexes were the high-quality embryo rate,the implantation rate,the biochemical pregnancy rate,the abortion rate,etc.Results There were no statistically significant differences between the two groups in age,infertility duration,body mass index(BMI),anti-Müllerian hormone(AMH),total dosage and duration of gonadotropin(Gn)used,number of embryos transferred(all P>0.05).The live birth rate,the clinical pregnancy rate,the miscarriage rate,the normal fertilization rate,the cleavage rate,the embryo formation rate and the high-quality embryo rate were not significantly different between the two groups(all P>0.05).The implantation rate[40.47%(191/472)]and the biochemical pregnancy rate[64.20%(156/243)]were higher in dual trigger group than in r-hCG group[32.42%(272/893),P=0.003;55.35%(272/893),P=0.025].Conclusion Dual trigger of oocyte maturation with 250μg r-hCG plus 300 U uFSH has no benefit on the clinical pregnancy rate and the live birth rate,but could improve the implantation rate and the biochemical pregnancy rate in women undergoing short-acting GnRH-a protocol in IVF/ICSI-ET.