不同方案和不同来源胚胎的临床妊娠结局及子代差异性分析

Clinical pregnancy outcome and progeny difference analysis of embryos from different programs and different sources

目的 探讨超长方案和拮抗剂方案不同来源胚胎临床妊娠结局及子代差异性。方法 回顾性分析2018年1月至2022年6月赣州市妇幼保健院生殖与遗传科控制性超促排卵(controlled ovarian hyperstimulation,COH)助孕患者的随访数据,包括超长方案1000例周期,拮抗剂方案1000例周期,通过产妇姓名、年龄、胚胎情况等关键数据在赣州市妇幼保健院生殖与遗传科的体外受精(in vitro fertilization,IVF)系统中进一步筛选出在本科室助孕并怀孕的孕产妇,筛查出500例纳入本研究。其中超长方案组258例,拮抗剂方案组242例;根据移植胚胎性质分为囊胚组258例,卵裂胚组242例;根据移植周期方式分为新鲜周期组224例,解冻周期组276例。分析比较两组患者的一般情况、种植率、临床妊娠率、早期流产率,并检测两组外周血中hCG日窦状卵泡数(human chorionic gonadotrophin antral follicle count,hCGAFC)、hCG前日雌二醇(hCG pre-day estradiol,PhCGE_(2))、hCG日雌二醇(hCG daily estradiol,hCGE_(2))、hCG日孕酮(hCG daily progesterone,hCGP)、hCG日黄体生成素(hCG daily luteinizing hormone,hCGLH)水平。记录两组卵巢过度刺激综合征(orian hyperstimulation syndrome,OHSS)发生率及新生儿并发症情况。结果 超长方案组的平均获卵数、囊胚形成率、优质囊胚率比较,差异均无统计学意义(P>0.05);超长方案组Gn总用量与用药时长均高于拮抗剂组,差异有统计学意义(P<0.05);两组患者hCGP比较,差异无统计学意义(P>0.05),但超长方案组PhCGE_(2)、hCGE_(2)及hCGAFC均较拮抗剂方案组明显升高,而hCGLH则明显降低(P<0.05)。此外,超长方案组OHSS发生率和临床妊娠率均更高(P<0.05);超长方案和拮抗剂方案来源的胚胎,无论囊胚或卵裂期胚胎,无论采用新鲜周期或解冻周期移植,两组新生儿分娩孕周、出生体重、新生儿性别、出生缺陷比较,差异均无统计学意义(P>0.05)。结论 超长方案和拮抗剂方案来源胚胎的子代差异性较小,但超长方案的新鲜临床妊娠率更高,更适合卵巢储备正常反应患者,采用新鲜周期移植;而拮抗剂方案有助于降低OHSS的发生风险,安全性更好,更适合卵巢储备高反应患者,采用解冻周期移植。

Objective To investigate the clinical pregnancy outcome and offspring difference of embryos from different sources of ultra-long protocol and antagonist regimen.Methods The follow-up data of controlled ovarian hyperstimulation(COH)assisted pregnancy in the Department of Reproduction and Genetics,Ganzhou Maternal and Child Health Hospital from January 2018 to June 2022 were retrospectively analyzed,including 1000 cycles of ultra-long regimen and 1000 cycles of antagonist regimen.Through the key data of maternal “name,age,embryo status” and so on,pregnant women assisted in pregnancy in the department were further screened out from the in vitro fertilization(IVF) system of Department of Reproduction and Genetics,Ganzhou Maternal and Child Health Hospital,and 500 cases were screened and included in this study.In addition,258 patients were assigned to the ultra-long regimen and 242 patients were assigned to the Gn RH antagonist regimen.According to the properties of transplanted embryos,258 cases were divided into blastocyst group and 242 cases were divided into blastocyst group.There were 224 cases in fresh cycle group and 276 cases in thawed cycle group.The general situation,implantation rate,clinical pregnancy rate and early abortion rate of the two groups were analyzed and compared.The human chorionic gonadotrophin hCG antral follicle count(hCGAFC),hCG pre-day estradiol(PhCGE_2),hCG daily estradiol(hCGE_2),hCG daily progesterone(hCGP),and hCG daily luteinizing hormone(hCGLH) levels in peripheral blood of the two groups were detected.The incidence of orian hyperstimulation syndrome(OHSS) and neonatal complications were recorded in the two groups.Results There were no significant differences in the average number of eggs obtained,blastocyst formation rate and high quality blastocyst rate in the ultra-long protocol group(P<0.05).The total dosage and duration of Gn in ultra-long regimen group were higher than those in gonadotropin-releasing hormone(GnRH) antagonist regimen group,and the difference was statistically significant(P<0.05).There was no significant difference in hCGP between the two groups(P<0.05),but PhCGE_2,hCGE_(2) and hCGAFC in the ultra-long regimen group were significantly higher than those in the GnRH antagonist regimen group,while hCGLH was significantly lower(P<0.05).In addition,the incidence of OHSS and clinical pregnancy rate were higher in the ultra-long regimen group(P<0.05).There were no differences in gestational weeks,birth weight,neonatal gender and birth defects between the two groups(P<0.05) for embryos from the ultra-long regimen and GnRH antagonist regimen,regardless of blastula or cleavage stage embryos,regardless of fresh cycle or thawing cycle transplantation.Conclusion There was little difference in neonatal complications between the embryos derived from ultra-long regimen and GnRH antagonist regimen,but the ultra-long regimen had a higher rate of fresh clinical pregnancy,which was more suitable for patients with normal ovarian reserve response,and fresh cycle transplantation was adopted.However,GnRH antagonist regimen is helpful to reduce the risk of OHSS and has better safety.It is more suitable for patients with high ovarian reserve response,and thawing cycle transplantation is adopted.