波塞冬1组患者重复周期应用早卵泡期长效长方案和拮抗剂方案的疗效比较及自身对照研究

Self-control study on efficacy of early follicular phase long-acting long protocol and antagonist protocol in repeated cycles of patients in Poseidon group 1

目的探讨早卵泡期长效长方案和拮抗剂方案在波塞冬1组患者重复周期中的应用疗效及优化策略。方法选择2018年6月至2022年6月于安徽省妇幼保健院生殖中心行体外受精(IVF)/卵胞浆内单精子注射(ICSI)治疗、采用常规控制性促排卵(COH)方案发生非预期卵巢低反应(uPOR)、且助孕失败后再次助孕的波塞冬1组患者286例为研究对象,根据重复周期COH方案不同分为早卵泡期长效长方案组(简称早长方案组,n=119例)和拮抗剂方案组(n=167例),比较两组实验室指标及临床妊娠结局;并将其中前后两个周期均采用相同COH方案的124例患者分为双早长方案组(n=70例)和双拮抗剂方案组(n=54例),采用自身对照研究分析两组临床资料。结果(1)再次COH周期早长方案组与拮抗剂方案组患者间基础资料比较无统计学差异(P>0.05)。早长方案组促性腺激素(Gn)总量、Gn天数、HCG日E_(2)水平、获卵数、可用胚胎数及优质胚胎数均显著高于拮抗剂方案组(P<0.05),HCG日LH水平显著低于拮抗剂方案组(P<0.05),其鲜胚种植率、鲜胚临床妊娠率及累积妊娠率较拮抗剂方案组有升高趋势,但无统计学差异(P>0.05);两组患者间周期取消率、中重度卵巢过度刺激综合征(OHSS)发生率、HCG日孕酮(P)水平、HCG日内膜厚度、再次uPOR发生率及早期流产率等比较均无统计学差异(P>0.05)。(2)双早长方案组的自身对照比较结果显示,再次早长方案组Gn启动剂量、LH添加量、HCG日E_(2)水平、获卵数、可用胚胎数、优质胚胎数、正常受精率、优质胚胎率、鲜胚种植率和临床妊娠率均显著高于首次早长方案组(P<0.05),早期流产率显著低于首次早长方案组(P<0.05)。(3)双拮抗剂方案组的自身对照比较结果显示,再次拮抗剂方案组Gn启动剂量、LH添加量、获卵数、可用胚胎数、优质胚胎数、鲜胚种植率及临床妊娠率等均显著高于首次拮抗剂方案组(P<0.05)。结论对于波塞冬1组患者来说,早卵泡期长效长方案和拮抗剂方案均可作为重复周期的促排卵方案;从获卵数及鲜胚临床妊娠结局考虑,早卵泡期长效长方案优于拮抗剂方案;从经济成本考虑,拮抗剂方案优于早卵泡期长效长方案。重复周期可根据两个方案的劣势采取优化措施来改善患者对于促排卵方案的反应性及卵母细胞质量和数量等问题,从而改善IVF/ICSI预后。

Objective:To investigate the application efficacy and optimization strategy of early follicular phase long-acting long protocol and antagonist protocol in repeated cycles of the patients in Poseidon group 1.Methods:A total of 286 patients in Poseidon 1 group who underwent IVF/ICSI and experienced unexpected poor ovarian response(uPOR)after using conventional controlled ovarian hyper-stimulation(COH)protocol and accepted assistant pregnancy again after failed to conceive at the reproductive center of Anhui Maternal&Child Health Hospital from June 2018 to June 2022 were selected.According to the different COH protocols in repeated cycles,the patients were divided into two groups:the early follicular phase long-acting long protocol group(long-acting long protocol group,n=119)and antagonist protocol group(n=167).The laboratory data and clinical outcomes of the two groups were compared.Meanwhile,124 patients who used the same COH protocol in both cycles were divided into two groups:double long-acting long protocol group(n=70)and double antagonist protocol group(n=54).The clinical data of the two groups were analyzed by self-control study.Results:(1)There was no significant difference in basic data between patients in the long-acting long protocol and the antagonist protocol group(P>0.05).Total dosage of gondotropin(Gn)used,duration of Gn used,E_(2)level on HCG day,number of oocytes retrieved,number of available embryos in the long-acting long protocol group were significantly higher than those in the antagonist protocol group(P<0.05),while the LH level on HCG day was significantly lower than that of the antagonist group(P<0.05).The fresh cycle embryo implantation rate and clinical pregnancy rate,cumulative pregnancy rate in the long-acting long protocol group were slightly higher than those in the antagonist protocol group,but there was no significant difference(P>0.05).There were no significant differences in the cycle cancellation rate,incidence of moderate and severe OHSS,progesterone level and endometrial thickness on HCG day,incidence of recurrent uPOR and early abortion rate between the two groups(P>0.05).(2)The self-control comparison of double the long-term protocol group showed that the initial dose of Gn,the amount of LH addition,E_(2)level on HCG day,number of oocytes retrieved,number of available embryos,number of good-quality embryos,normal fertilization rate,high-quality embryo rate,fresh embryo implantation rate and clinical pregnancy rate in the second cycle were significantly higher than those in the first cycle(P<0.05).(3)The self-control comparison of the double antagonist protocol group showed that the initial dose of Gn,the amount of LH addition,number of oocytes retrieved,number of high-quality embryos,the fresh cycle embryo implantation rate and clinical pregnancy rate in the second cycle were significantly higher than those in the first cycle(P<0.05).Conclusions:For the patients in Poseidon group 1,both the early follicular phase long-acting long protocol and antagonist protocol can be used as COH protocols in repeated cycles.In terms of number of oocytes retrieved and the clinical pregnancy outcome of fresh cycle,the early follicular phase long-acting long protocol is superior to the antagonist protocol.In terms of economic cost,the antagonist protocol is better than the early follicular phase long-acting long protocol.According to the disadvantages of the two protocols,optimization strategies can be taken to improve the patient’s responsiveness of COH and the quality and quantity of oocytes,so as to improve the prognosis of IVF/ICSI.