微刺激与拮抗剂方案应用于波塞冬低预后患者的疗效比较

Comparison of the efficacy of mild stimulation protocol and antagonist protocol in patients with low prognosis according to POSEIDON criteria

目的分析比较微刺激方案与拮抗剂方案应用于波塞冬低预后3组、4组患者的疗效。方法选取2017年3月至2020年3月唐山市妇幼保健院采用微刺激方案、拮抗剂方案行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的322例波塞冬低预后患者进行回顾性分析,根据不同方案分为拮抗剂组(n=154)和微刺激组(n=168)。比较两组基线资料和控制性促排卵结局,应用多因素Logistic回归分析患者临床妊娠的可能影响因素。结果与拮抗剂组相比,微刺激组的促性腺激素(Gn)天数更短、Gn用量更少、移植日内膜更薄、全胚冷冻率更高(P<0.05)。经Logistic回归分析显示,应用何种控制性促排卵方案与临床妊娠无显著相关性(P>0.05),波塞冬3组比4组患者更易获得临床妊娠(OR=3.352,95%CI:1.208~9.302,P=0.020),抗米勒管激素(AMH)≥0.61 ng/mL者比<0.61 ng/mL者更易获得临床妊娠(OR=3.260,95%CI:1.342~7.919,P=0.009)。结论对于波塞冬低预后3组、4组患者,微刺激方案和拮抗剂方案有相似的临床和实验室结局。微刺激方案用药的时间短、Gn用量少,尤其适用于有全胚冷冻需求的患者。

Objective To evaluate the efficacy of mild stimulation protocol and antagonist protocol in low prognosis of POSEIDON 3 and 4 group.Methods A retrospective analysis was performed on 322 patients with low prognosis of POSEIDON who underwent in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)using mild stimulation protocol and antagonist protocol in Tangshan Maternal and Child Health Care Hospital from March 2017 to March 2020.They were divided into antagonist protocol group(n=154)and mild stimulation protocol group(n=168).The baseline data and outcome of controlled ovulation were compared between two groups.Multivariate Logistic regression was used to analyze the possible influencing factors of clinical pregnancy rate.Results The stimulation days,dosage of gonadotropin(Gn)used and endometrial thickness were significantly lower in mild stimulation protocol group compared with antagonist protocol group(P0.05).Higher freeze-only strategy rate was observed in mild stimulation protocol group(P0.05).Logistic regression model suggested that the clinical pregnancy rate was of no significant difference between different controlled ovulation induction regimen(P0.05).Patients in POSEIDON 3 group were significantly easier to achieve clinical pregnancy compared with those in POSEIDON 4 group(OR=3.352,95%CI:1.208-9.302,P=0.020).And the patients whose anti-Müllerian hormone(AMH)≥0.61 ng/mL were significantly easier to achieve clinical pregnancy compared with those whose AMH0.61 ng/mL(OR=3.260,95%CI:1.342-7.919,P=0.009).Conclusions For patients with low prognosis of POSEIDON 3 and 4 group,mild stimulation protocol can achieve similar clinical and laboratory outcome as the antagonist protocol,with shorter treatment cycle and less usage of Gn,which is especially suitable for patients with the need of freeze-only strategy.