生长激素预治疗对卵巢储备功能低下患者IVF/ICSI-ET助孕结局的影响

Effect of growth hormone pretreatment on IVF/ICSI-ET assisted pregnancy outcomes in patients with poor ovarian reserve

目的探讨生长激素(growth hormone,GH)预治疗在卵巢储备功能低下女性体外受精/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)的疗效。方法采用回顾性队列研究,分析2018年10月至2019年10月期间在北京大学第三医院生殖医学中心接受IVF/ICSI-ET助孕,行拮抗剂方案控制性卵巢刺激(controlled ovarian stimulation,COS),且基于波塞冬标准3组及4组的卵巢储备功能低下患者的临床资料。根据患者是否应用GH预治疗,分为GH组(n=103)及对照组(n=197)。GH组促排卵前接受2 U/d GH皮下注射4周,促排卵期间剂量调整为4 U/d,继续使用至扳机日,对照组未使用GH,分析比较两组的临床结局。结果女方年龄、不孕年限、体质量指数(body mass index,BMI)、抗苗勒管激素(anti-Müllerian hormone,AMH)、基础窦卵泡计数(antral follicle count,AFC)、基础卵泡刺激素(follicle-stimulating hormone,FSH)组间比较差异均无统计学意义(均P>0.05)。促性腺激素(gonadotropin,Gn)使用时间、Gn用量、人绒毛膜促性腺激素(human chorionic hormone,hCG)注射日雌二醇水平及子宫内膜厚度组间差异均无统计学意义(均P>0.05)。GH组获卵数与对照组相比差异无统计学意义(P>0.05)。GH组的可利用胚胎数[(2.62±2.41)枚]显著高于对照组[(1.51±1.56)枚],差异有统计学意义(P<0.001)。GH组56个新鲜移植周期,对照组106个新鲜移植周期,两组移植日子宫内膜厚度、移植胚胎数组间差异均无统计学意义(均P>0.05)。GH组与对照组新鲜移植周期临床妊娠率、流产率、活产率差异均无统计学意义(均P>0.05)。结论促排卵前4周开始GH预治疗并持续至扳机日可增加卵巢储备功能低下患者拮抗剂方案的可利用胚胎数。

Objective To investigate the effect of growth hormone(GH)pretreatment on in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in women with poor ovarian reserve.Methods A retrospective cohort study was conducted to analyze the clinical data of women who underwent IVF/ICSI-ET with gonadotropin-releasing hormone(GnRH)antagonist protocol in Reproductive Medicine Center of Peking University Third Hospital from October 2018 to October 2019.Patients with poor ovarian reserve belong POSEIDON group 3 or POSEIDON group 4 were included as the research objects and were divided into GH group(n=103)and control group(n=197)by pretreated with GH or not.GH group received 2 U/d subcutaneous injection of GH for 4 weeks before ovulation induction,and the dosage was adjusted to 4 U/d until the trigger day during ovulation induction.GH was not used in control group.The clinical outcomes of the two groups were analyzed and compared.Results There were no significant differences in general condition between GH group and control group including age,infertility duration,body mass index(BMI),anti-Müllerian hormone(AMH),basal follicle-stimulating hormone(FSH)and antral follicle count(AFC,all P>0.05).No significant differences were found in the duration of gonadotropin(Gn)used,total dosage of Gn used,estrogen levels and the endometrial thickness on human chorionic hormone(hCG)injection day between the two groups(all P>0.05).Furthermore,no statistically significant difference was found in the number of oocytes retrieved between GH group and control group(P>0.05).The number of available embryos in GH group(2.62±2.41)was significantly higher than that in control group(1.51±1.56,P<0.001).There were 56 fresh embyo transfer cycles in GH group and 106 fresh embyo transfer cycles in control group.There were no statistically significant differences in endometrial thickness on fresh embyo transfer day and the number of embryos transferred between GH group and control group(all P>0.05).No statistically significant differences were found in clinical pregnancy rate,miscarriage rate and live delivery rate after fresh embyo transferred between the two groups(all P>0.05).Conclusion GH pretreatment for 4 weeks before controlled ovarian sitmulation and continued use till the trigger day may improve number of the available embryos in poor ovarian reserve patients with GnRH antagonist.