GnRH-a加强黄体支持对拮抗剂方案促排卵患者鲜胚移植结局的影响

Effect of GnRH-a strengthening luteal support on the outcome of freshembryo transfer in ovulation promotion patients with antagonist regimen

目的比较传统黄体支持与使用GnRH-a加强黄体支持对拮抗剂方案促排卵患者鲜胚移植结局的影响。方法回顾性分析2018年1月至2021年5月在北京朝阳医院生殖医学中心接受拮抗剂方案促排卵行新鲜胚胎移植的患者,共183个周期。按不同黄体支持分为3组,对照组:胚胎移植后常规黄体酮支持,即单独使用肌注黄体酮(60 mg/d)持续至验孕日;研究组1:在常规黄体支持方案基础上,于取卵后第6天添加1次GnRH-a加强黄体支持;研究组2:在常规黄体支持方案基础上,于取卵后第6、8、10天添加3次GnRH-a加强黄体支持。比较3组妊娠率、继续妊娠率等治疗结局的差异。结果3组年龄、BMI、基础内分泌等比较,差异无统计学意义(P>0.05);研究组1与对照组相比,临床妊娠率增高(54.7%vs 35.5%),研究组2与对照组相比临床妊娠率升高(56.1%vs 35.5%),差异有统计学意义(P<0.05);研究组1与研究组2临床妊娠率、持续妊娠率、异位妊娠率、活产率和早期妊娠丢失率比较,差异无统计学意义(P>0.05)。结论使用GnRH-a加强黄体支持可帮助提高拮抗剂方案促排卵鲜胚移植患者妊娠率。

Objective To compare the effects of traditional luteal support and GnRH-a enhanced luteal support on the outcome of fresh embryo transfer.Methods From January 2018 to May 2021,183 cycles of fresh embryo transfer in ovulation induction patients with antagonist regimen in Reproductive Medicine Center of Bejing Chao-Yang Hospital were retrospectively analyzed.They were divided into three groups according to different luteal support.The control group received conventional progesterone support after embryo transfer,intramuscular progesterone(60 mg/d)was used alone until the pregnancy test day;Study group l:on the basis of routine luteal support regimen,GnRH-a was added once on the 6th day after transplantation to enhance luteal support.Study group 2:on the basis of routine luteal support regimen,GnRH-a was added three times on the 6th,8th day and 1Oth day after transplantation to enhance luteal support.Pregnancy rate,continued pregnancy rate and other treatment outcomes were compared among the three groups.Resulsts There were no significant differences in age,BMI and basic endocrine among the three groups(P>0.05).Compared with the control group,the clinical pregnancy rate in study group 1 was higher(54.7%vs 35.5%),and the clinical pregnancy rate in study group 2 was significantly higher(56.1%vs 35.5%),the differences were statistically significant(P<0.05).There was no significant difference in clinical pregnancy rate,persistent pregnancy rate,ectopic pregnancy rate,live birth rate and early pregnancy loss rate between study group 1 and study group 2(P>0.05).Conclusion The use of GnRH-a to enhance luteal support can improve the pregnancy rate of fresh embryo transfer patients with ovulation induction regimen.