拮抗剂方案与卵泡期长效长方案应用于波塞冬标准组4卵巢低反应患者妊娠结局的比较

Compare the pregnancy outcomes between the antagonist protocol and the follicular phase long-acting long protocol in the fourth subgroup of POSEIDON criteria

目的探讨波塞冬(POSEIDON)标准组4卵巢低反应(POR)患者应用拮抗剂方案和卵泡期长效长方案在体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)中的妊娠结局。方法回顾性分析2017年1月至2021年12月就诊于本院生殖医学中心首次行IVF/ICSI-ET新鲜周期移植助孕的符合POSEIDON标准组4的POR患者的临床资料。根据助孕方案的不同及纳入标准共收集446个周期,根据促排卵方案不同分为两组:拮抗剂方案组(395个周期),卵泡期长效长方案组(51个周期)。比较两组患者的相关临床及实验室数据。结果①长效长方案组的重组人促性腺激素(Gn)总量、Gn时间、人绒毛促性腺激素(hCG)、日子宫内膜厚度、hCG日孕激素(P)水平显著高于拮抗剂方案组(P<0.05),长效长方案组hCG日黄体生成素(LH)水平显著低于拮抗剂方案组(P<0.05);②长效长方案组的获卵数[(5.1±2.5)枚;(3.9±2.7)枚]、成熟卵子(MⅡ)数[(3.8±2.8)枚;(2.7±2.3)枚]显著高于拮抗剂方案组(P<0.05),两组受精率、周期取消率比较,差异无统计学意义(P>0.05);③长效长方案组的胚胎种植率[41.4%(17/41)]与拮抗剂方案组[20.7%(80/386)]比较,差异有统计学意义(P<0.05)、长效长方案组的临床妊娠率[50%(15/30)]与拮抗剂方案组[27.4%(73/266)]比较,差异均有统计学意义(P<0.05);④两组的胚胎移植数、早期流产率、早产率比较,差异均无统计学意义(P>0.05),长效长方案组的活产率[23.3%(7/30)]优于拮抗剂组[15.4%(41/266)],但两组比较,差异无统计学意义(P>0.05);⑤两组新生儿的性别、Apgar评分、身长、体重、畸形率比较,差异均无统计学意义(P>0.05)。结论在符合POSEIDON标准组4 POR患者中应用卵泡期长效长方案的获卵数、胚胎种植率、临床妊娠率、活产率明显优于拮抗剂方案组;但是前者在促排卵过程中Gn使用量更多,耗时更长。

Objective To investigate the pregnancy outcomes of IVF/ICSI-ET in subgroup 4 of the POSEIDON standard group using the antagonist protocol and the follicular phase prolonged protocol.Methods The clinical data of POSEIDON criteria subgroup 4 patients who underwent IVF/ICSI-ET fresh cycle transfer for the first time in the Reproductive Medicine Center of our hospital from January 2017 to December 2021 were retrospectively analyzed.A total of 446 cycles were collected according to the different ART protocols and inclusion criteria.According to different ovulation induction protocols,they were divided into two groups:antagonist protocol group(395 cycles)and follicular phase long-term protocol group(51 cycles).Results①The total amount of Gn,Gn time,hCG,endometial thickness and P level on hCG day in long-acting long protocol group were significantly higher than those in antagonist protocol group(P<0.05).The LH level on hCG day in long-acting long protocol group were significantly lower than those in antagonist protocol group(P<0.05).②The number of oocytes retrieved[(5.1±2.5);(3.9±2.7)]and mature oocytes(MⅡ)[(3.8±2.8);(2.7±2.3)]in the long-acting long protocol group were significantly higher than those in the antagonist protocol group(P<0.05).There was no significant difference in the fertilization rate and cycle cancellation rate between the two groups(P>0.05).③The embryo implantation rate of the long-acting long protocol group[41.4%(17/41)]was significantly different from that of the antagonist protocol group[20.7%(80/386)](P<0.05).The clinical pregnancy rate of the long-acting long protocol group[50%(15/30)]was significantly different from that of the antagonist protocol group[27.4%(73/266)](P<0.05).The differences were all significant(P<0.05).④There were no significant differences in the embryo transfer number,early abortion rate and premature birth rate between the two groups(P>0.05).The live birth rate of the long-acting long group[23.3%(7/30)]was higher than that of the antagonist group[15.4%(41/266)],but there was no significant difference between the two groups(P>0.05).⑤There was no significant difference in gender,Apgar score,length,weight and deformity rate between the two groups(P>0.05).Conclusion In the subgroup 4 of the POSEIDON criteria,the number of oocytes retrieved,embryo implantation rate,clinical pregnancy rate and live birth rate of follicular phase long-acting long protocol were significantly better than those of the antagonist protocol group.However,the use of Gn in the former group is more and takes longer time.