GnRH拮抗剂低剂量灵活管理方案对卵巢储备功能正常患者IVF-ET新鲜周期妊娠结局影响

Effect of GnRH Antagonist Low-dose Flexible Management Scheme on PregnancyOutcome of IVF-ET Fresh Cycle in Patients with Normal Ovarian Reserve Function

观察促性腺激素释放激素拮抗剂(GnRH-ant)低剂量灵活管理方案对卵巢储备功能正常患者体外受精-胚胎移植(IVF-ET)新鲜周期妊娠结局影响。回顾性分析2019年1月至2021年1月于本院行IVF-ET助孕的卵巢储备功能正常不孕患者92例的临床资料,根据患者采用的GnRH-ant方案分为低剂量灵活方案组(n=47)和固定方案组(n=45),比较两组排卵用药情况、临床结局及新鲜周期的妊娠结局。结果显示低剂量灵活方案组Gn使用天数短于固定方案组,Gn总量少于固定方案组,人绒毛膜促性腺激素(HCG)注射日雌二醇(E_(2))水平高于固定方案组(P<0.05),两组HCG注射日黄体生成素(LH)、孕酮(P)水平和子宫内膜厚度比较无显著差异(P>0.05)。低剂量灵活方案组优质胚胎数高于固定方案组(P<0.05),两组获卵数、成熟卵数、受精率、早发LH峰发生率、卵巢过度刺激综合征(OHSS)发生率比较无显著差异(P>0.05)。低剂量灵活方案组临床妊娠率高于固定方案组(P<0.05),两组新鲜移植胚胎数、生化妊娠率比较无显著差异(P>0.05)。对年龄<35岁者,低剂量灵活方案组Gn总量低于固定方案组,HCG注射日E_(2)水平、优质胚胎数、临床妊娠率高于固定方案组(P<0.05),两组HCG注射日子宫内膜厚度、获卵数比较无显著差异(P>0.05);对年龄≥35岁者,低剂量灵活方案组和固定方案组妊娠结局各项指标比较无显著差异(P>0.05)。对于卵巢储备功能正常,初次接受IVF-ET助孕的不孕患者,GnRH-ant低剂量灵活方案可获得更多的优质胚胎,并降低Gn总量和天数,提高临床妊娠率。

To observe the effect of low-dose flexible management of gonadotropin-releasing hormone antagonist(GnRH-ant)on the pregnancy outcome of fresh cycle of in vitro fertilization-embryo transfer(IVF-ET)in patients with normal ovarian reserve,the clinical data of 92 infertile patients with normal ovarian reserve function who underwent IVF-ET in the hospital from January 2019 to January 2021 were retrospectively analyzed.According to the GnRH-ant regimen adopted by the patients,they were divided into low-dose flexible regimen group(n=47)and fixed regimen group(n=45).Ovulation medication,clinical outcome and pregnancy outcome of fresh cycle were compared between the two groups.The days of Gn use in the low-dose flexible regimen group were shorter than those in the fixed regimen group,the total amount of Gn was less than that in the fixed regimen group,and the level of estradiol(E_(2))on the injection day of human chorionic gonadotropin(HCG)was higher than that in the fixed regimen group(P<0.05).There were no significant differences in the levels of luteinizing hormone(LH),progesterone(P)and endometrial thickness on HCG injection day between the two groups(P>0.05).The number of high-quality embryos in the low-dose flexible regimen group was higher than that in the fixed regimen group(P<0.05),and there were no significant differences in the number of oocytes obtained,mature oocytes,fertilization rate,incidence of early-onset LH peak and incidence of ovarian hyperstimulation syndrome(OHSS)between the two groups(P>0.05).The clinical pregnancy rate of the low-dose flexible regimen group was higher than that of the fixed regimen group(P<0.05),and there were no significant differences in the number of fresh transferred embryos and biochemical pregnancy rate between the two groups(P>0.05).For those aged<35 years,the total Gn amount in the low-dose flexible regimen group was lower than that in the fixed regimen group,and the E_(2)level,number of high-quality embryos and clinical pregnancy rate on the day of HCG injection were higher than those in the fixed regimen group(P<0.05).There were no significant differences in endometrial thickness and number of oocytes retrieved between the two groups on the day of HCG injection(P>0.05).For those aged≥35 years,there was no significant difference in pregnancy outcome between the low-dose flexible regimen group and the fixed regimen group(P>0.05).For infertile patients with normal ovarian reserve function and receiving IVF-ET for the first time,GnRH-ant low-dose flexible regimen can obtain more high-quality embryos,reduce the total amount of Gn and the number of days,and improve the clinical pregnancy rate.