拮抗剂总剂量对卵巢正常反应人群IVF/ICSI妊娠结局的影响

Effect of total doses of GnRH-antagonist on IVF/ICSI pregnancy outcome in the patients with normal ovarian response

目的探讨拮抗剂方案中拮抗剂总剂量对卵巢正常反应人群体外受精/卵胞浆内单精子注射(IVF/ICSI)临床妊娠结局的影响。方法回顾性分析2019年3月至2022年7月于我院使用拮抗剂方案促排卵的卵巢正常反应患者共207个新鲜移植周期的临床资料。根据不同的拮抗剂总剂量分为2组:拮抗剂总剂量≤1 mg为A组(n=114)和拮抗剂总剂量>1 mg为B组(n=93);另外,根据HCG日雌二醇(E_(2))水平进行亚组分析:A组分为A1(E_(2)≤9175 pmol/L,n=69)和A2组(E_(2)>9175 pmol/L,n=45),B组分为B1(E_(2)≤9175 pmol/L,n=44)和B2组(E_(2)>9175 pmol/L,n=49)。比较各组间患者的一般情况、促排卵情况及临床妊娠结局。结果A、B两组间患者一般情况比较均无显著差异(P>0.05)。A组拮抗剂使用天数、HCG日E_(2)水平、HCG日≥14 mm卵泡数均显著低于B组(P<0.05),A组胚胎着床率、HCG阳性率及临床妊娠率显著高于B组(P<0.05)。4个亚组间比较发现,与A1组相比较,A2组窦卵泡计数(AFC)、抗苗勒管激素(AMH)、HCG日E_(2)、孕酮(P)水平、HCG日≥14 mm卵泡数、获卵数均显著升高(P<0.05),但两组间妊娠结局无显著差异(P>0.05);B2组HCG阳性率、临床妊娠率显著低于其他3个亚组(P<0.05)。结论对于采用拮抗剂方案助孕的卵巢反应正常患者,减少拮抗剂的使用剂量能显著改善鲜胚移植妊娠结局,节约时间成本;临床应结合拮抗剂总剂量和HCG日E_(2)水平,个体化制定移植策略。

Objective:To investigate the effect of total doses of GnRH-antagonist on IVF/ICSI clinical pregnancy outcome in normal ovarian responders.Methods:The clinical data of 207 patients with normal ovarian response who were treated with GnRH antagonist protocol to induce ovulation during the fresh transplantation cycle at the Reproductive Medical Center of Renmin Hospital of Wuhan University from March 2019 to July 2022 were retrospectively analyzed.According to the total doses of GnRH-antagonists,they were divided into group A(total doses of antagonist≤1 mg,n=114)and group B(total dose of antagonist>1 mg,n=93).In addition,according to the estradiol(E_(2))level on HCG day,each group was divided into two subgroups:group A was divided into A1(E_(2)≤9175 pmol/L,n=69)and A2(E_(2)>9175 pmol/L,n=45),group B was divided into B1(E_(2)≤9175 pmol/L,n=44)and B2(E_(2)>9175 pmol/L,n=49).The general condition,ovulation induction and clinical pregnancy outcome were compared among the groups.Results:There was no significant difference in the general condition of patients between group A and B(P>0.05).The days of GnRH-antagonist used,E_(2) levels on HCG day,and the number of follicles≥14 mm on HCG day in group A were significantly lower than those in group B(P<0.05).The embryo implantation rate,HCG positive rate and clinical pregnancy rate in group A were significantly higher than those in group B(P<0.05).Comparison among the four subgroups found that the antral follicle count(AFC),anti-Mullerian hormone(AMH),E_(2)&progesterone(P)levels on HCG day,≥14 mm follicle count on HCG day and oocyte retrieval were significant increased in group A2 compared with group A1(P<0.05),but there was no significant difference in pregnancy outcomes between the two groups(P>0.05).The HCG positive rate and clinical pregnancy rate in group B2 were significantly lower than those in the other three subgroups(P<0.05).Conclusions:In the patients with normal ovarian response who received GnRH-antagonist protocol for assisted pregnancy,reducing the total doses of GnRH-antagonist can significantly improve pregnancy outcome and save time and cost.In clinical practice,individualized embryo transfer strategies should be developed based on the total doses of GnRH-antagonists and the E_(2) level on HCG day.