GnRHa黄体支持在IVF/ICSI-ET中的应用

Application of gonadotropin-releasing hormone agonist for luteal support in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer

目的探讨拮抗剂方案鲜胚移植黄体中期添加促性腺激素释放激素激动剂(GnRHa)对临床妊娠结局的影响。方法选取2020年1月至2023年2月行拮抗剂方案鲜胚移植IVF/ICSI 314例患者临床资料。在常规黄体支持基础上,根据添加不同剂量GnRHa,分为A组(0 mg,n=95)、B(在取卵后第6天皮下注射0.1 mg GnRHa,n=92)、C组(于取卵第2、5、8天单次皮下注射0.1 mgGnRHa,n=55)、D组(于取卵第2、4天单次皮下注射0.2 mg GnRHa,n=72),比较4组的妊娠结局。将314例分为临床妊娠组和非临床妊娠组,行单因素分析和logistic回归分析,探索影响ART妊娠结果的重要因素。结果4组患者年龄、不孕年限、体重指数(BMI)、抗苗勒管激素(AMH)、窦卵泡数(AFC)、获卵数、MⅡ数、2PN数、优质D3胚胎数差异均无统计学意义(P>0.05);A组临床妊娠率低于B、C、D组(P<0.05),4组种植率、早期流产率、多胎率差异无统计学意义(P>0.05)。Logistic回归分析发现,平均移植胚胎数、GnRHa黄体支持占比均与妊娠结局有相关性(P<0.05)。结论拮抗剂鲜胚移植黄体中期添加GnRHa可提高临床妊娠率,且安全的多剂量间断给药临床妊娠率方面效果更明显。平均移植胚胎数是影响临床妊娠结局的关键因素。

Objective To explore the effect of adding gonadotropin-releasing hormone agonist(GnRHa)in the mid-luteal phase of fresh embryo transfer in the antagonist protocol on the pregnancy outcome.Methods The clinical data of 314 patients undergoing fresh embryo transfer using in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)from January 2020 to February 2023 were collected.On the basis of conventional luteal support,they were divided into group A(0mg,n=95),B(subcutaneous injection of 0.1mg GnRHa on the 6th day after egg retrieval,n=92),C(single subcutaneous injection of 0.1mg GnRHa on the 2nd,5th and 8th day of egg retrieval,n=55),and D group(single subcutaneous injection of 0.2 mg GnRHa on the 2nd and 4th day of egg retrieval,n=72)according to the addition of different doses of GnRH.Pregnancy outcomes of the four groups were compared.The cases were divided into clinical pregnancy group and non-pregnant group,and logistic regression analysis was performed to explore the important factors affecting the pregnancy outcome of assisted reproductive technology(ART).Results There were no significant differences in age,infertility years,body mass index(BMI),anti-Mullerian hormone(AMH),antral follicle count(AFC),number of eggs obtained,number of mature oocytes(MII),number of two pronuclei(2PN)embryos,and number of high-quality D3 embryos among the four groups(P>0.05).The clinical pregnancy rate in group A was significantly lower than that in group B,C,and D(P<0.05).There were no significant differences in implantation rate,early abortion rate,and multiple birth rate among the four groups(P>0.05).Logistic regression analysis found that the mean number of transferred embryos and the proportion of GnRHa for luteal support were correlated with pregnancy outcomes(P<0.05).Conclusion Adding GnRHa in the mid-luteal phase of fresh embryo transfer in the antagonist protocol can improve the clinical pregnancy rate,which is more pronounced by a safe multi-dose intermittent administration.The mean number of transferred embryos is a key factor influencing clinical pregnancy outcomes.