两种促排卵药物对不同年龄患者卵泡期长效长方案IVF/ICSI-ET助孕结局的影响

Effect of two ovulation-promoting drugs on clinical outcomes of IVF/ICSI-ET in patients of different ages with early follicular phase prolonged protocol

目的比较两种促排卵药物对不同年龄卵泡期长效长方案患者体外受精/卵泡浆内单精子注射胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)临床结局的影响。方法回顾性收集2016年1月至2022年7月在郑州大学第二附属医院生殖医学中心行卵泡期长效长方案IVF/ICSI-ET助孕的患者,按使用的促卵泡激素种类分为rFSH组(普丽康或果纳芬)和uFSH组(丽申宝),将两组患者按体质量指数、不孕年限、窦卵泡计数、基础卵泡刺激素、抗苗勒管激素进行1∶1倾向性评分,按照年龄分为A组(年龄<35岁,983例)、B组(35岁≤年龄<38岁,153例)、C组(年龄≥38岁,112例),对控制性促排卵结局和妊娠结局的相关数据进行比较,并将混杂因素纳入Logistic回归模型分析其对妊娠结局的影响。结果3组不同年龄患者中,uFSH组和rFSH组hCG日内膜厚度、受精率、胚胎着床率、临床妊娠率、流产率、活产率差异均无统计学意义(P>0.05),而uFSH组的Gn用药费用、hCG日P均低于rFSH组,差异有统计学意义(P<0.05);A组中uFSH组的Gn启动量、Gn时间、Gn总量、hCG日LH高于rFSH组,而hCG日E2、获卵数、可利用胚胎数低于rFSH组,差异有统计学意义(P<0.05);B组中uFSH组的Gn时间、Gn总量、卵裂率、优质胚胎率高于rFSH组,而hCG日E2低于rFSH组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:以rFSH组为参照,uFSH组的临床妊娠率差异无统计学意义[(OR=1.16,95%CI(0.914-1.472),P=0.223)],hCG日P是影响临床妊娠率的重要因素[(OR=0.72,95%CI(0.636-0.976),P=0.029)],获卵数的增多[(OR=0.944,95%CI(0.924-0.964),P<0.001)]和有效胚胎数的增加[(OR=1.176,95%CI(1.117-1.237),P<0.001)]有利于获得更高的临床妊娠率,年龄是影响临床妊娠率的重要因素[(OR=0.964,95%CI(0.940-0.988),P=0.004)],临床妊娠率随年龄的增加而降低。结论在卵泡期长效长方案中高纯度uFSH临床结局上与rFSH无显著差异,但经济成本更低;高龄患者选用uFSH在较低经济成本下可能获得更多优胚。

Objective To compare the effects of two ovulation induction drugs on the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in patients of different age with follicular phase prolonged protocol.Methods A retrospective analysis of patients who underwent IVF/ICSI-ET with follicular phase prolonged protocol from January 2016 to July 2022 in the Reproduction Center of the Second Affiliated Hospital of Zhengzhou University.According to the type of follicle stimulating hormone used,they were divided into rFSH group(Pulikon or Gonafen)and uFSH group(Lishenbao).Two groups of patients were matched with a 1∶1 propensity score based on body mass index,infertility years,antral follicle count,basal follicle stimulating hormone,and anti-Mullerian hormone.According to different age,all patients were divided into group A(35 years old below,n=983),group B(35 to 37 years old,n=153),group C(38 years old and above,n=112).Compared the relevant data of controlled ovulation induction outcomes and pregnancy outcomes,and incorporate confounding factors into Logistic regression modet to assess their impact on pregnancy outcomes.Results There was no statistically significant difference in endometrial thickness on the hCG injection day,fertilization rate,embryo implantation rate,clinical pregnancy rate,miscarriage rate,and live birth rate between the uFSH group and the rFSH group among the three groups of patients of different ages(P>0.05).However,the Gn medication cost and P on the hCG injection day of the uFSH group were lower than those of the rFSH group,and the differences were statistically significant(P<0.05).In group A,the starting dosage of Gn used,duration of Gn used,and total dosage of Gn used,and LH level on hCG injection day were higher in uFSH group than those in rFSH group,while the E2 level on hCG injection day,the number of oocytes retrieved and the number of available embryos were lower than those in rFSH group,and the differences were statistically significant(P<0.05);in group B,duration of Gn used,and total dosage of Gn used,the oocyte cleavage rate and the high-quality embryo rate were higher in uFSH group than those in rFSH group,while the E2 level on hCG injection day was lower than that in the rFSH group,and the difference was statistically significant(P<0.05).Multifactorial Logistic regression analysis showed that there was no statistically significant difference in the clinical pregnancy rate in the uFSH group,using the rFSH group as a reference[(OR=1.16,95%CI(0.914-1.472),P=0.223)],P level on hCG injection day was a significant factor in the clinical pregnancy rate[(OR=0.72,95%CI(0.636-0.976),P=0.029)],an increase in the number of oocytes retrieved[(OR=0.944,95%CI(0.924-0.964),P<0.001)]and an increase in the number of available embryos[(OR=1.176,95%CI(1.117-1.237),P<0.001)]favored a higher clinical pregnancy rate.Age was a significant factor in the clinical pregnancy rate[(OR=0.964,95%CI(0.940-0.988),P=0.004)],an increase in age led to a lower clinical pregnancy rate.Conclusions There is no significant difference in clinical outcomes between high-purity uFSH and rFSH in early follicular phase prolonged protocol,but the economic cost is lower.Elderly patients who choose uFSH may obtain more superior embryos at lower economic costs.