比较hCG联合GnRH-a双扳机和hCG单扳机方案对卵巢高反应人群的影响

Effects of double trigger human chorionic gonadotropin combined with gonadotropin-releasing hormone agonists compared with single trigger human chorionic gonadotropin in high ovarian responders

目的分析对比在拮抗剂方案中应用促性腺激素释放激素激动剂(GnRH-a)联合人绒毛膜促性腺激素(hCG)双扳机和hCG单扳机对卵巢高反应人群体外受精助孕周期的影响。方法回顾性收集2019年1月至2022年6月期间在广西壮族自治区妇幼保健院采用体外受精/卵胞质内单精子注射(IVF/ICSI)助孕、因卵巢高反应行全胚冷冻的260例患者的临床资料,其中使用双扳机为A组(n=131),使用hCG单扳机为B组(n=129)。比较分析两组新鲜周期内的2PN率、优质胚胎率等临床指标的差异,同时比较两组首次移植周期内的妊娠结局差异。结果两组新鲜周期的2PN率、卵裂率、D3可利用胚胎数、D3优胚数、D5优胚数、总囊胚数、囊胚形成率、卵巢过度刺激综合征(OHSS)发生率比较,差异无统计学意义(P>0.05);但A组冻存胚胎数高于B组,差异具有统计学意义(P=0.023)。A、B两组中重度OHSS发生率分别为1.52%和2.32%,差异无统计学意义(P=0.986),但A组为2例中度OHSS(住院治疗1例),B组为3例重度OHSS(住院治疗3例)。两组首次冻融周期的生化妊娠率、临床妊娠率、胚胎种植率、持续妊娠率、活产率等比较,差异无统计学意义(P>0.05)。结论在GnRH拮抗剂方案中,对卵巢高反应人群使用GnRH-a联合hCG双扳机,可与hCG单扳机同样诱发卵泡成熟及获卵,不影响其助孕结局,同时有利于降低中重度OHSS的发生。

Objective To analyze and compare the effects of using double trigger,gonadotropin-releasing hormone agonists(GnRH-a),combined with human chorionic gonadotropin(hCG)and hCG single trigger in high ovarian responders during in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)treatment cycles.Methods The clinical data of 260 patients who underwent IVF/ICSI and whole embryo freezing due to high ovarian response in Maternal&Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2019 to June 2022 were retrospectively collected.Among them,patients using double trigger were classified to Group A(n=131),patients using hCG single trigger were classified to Group B(n=129).The differences in clinical indicators such as 2 pronucleus(2PN)fertilization rate,high-quality embryo rate in the fresh cycle between the two groups were compared and analyzed,and the differences in pregnancy outcomes in the first transfer cycle between the two groups were also compared and analyzed.Results There was no significant difference in 2PN rate,cleavage embryo rate,number of D3 available embryos,number of D3 top-quality embryos,number of D5 top-quality embryos,number of total blastocysts,blastocyst formation rate and incidence of ovarian hyperstimulation syndrome(OHSS)between two groups in fresh cycle(P>0.05),but the number of frozen embryos in Group A was higher than that in Group B(P=0.023).The moderate to severe OHSS incidence rate in Group A and Group B was 1.52%and 2.32%,respectively,with no statistical significance(P=0.986),but there were 2 cases of moderate OHSS in Group A(1 patient was hospitalized)and 3 cases of severe OHSS in Group B(3 patient were hospitalized).There was no significant difference in biochemical pregnancy rate,clinical pregnancy rate,embryo implantation rate,ongoing pregnancy rate and live birth rate between the two groups in the first freeze-thaw embryo transfer cycle(P>0.05).Conclusions In the GnRH antagonist regimen,the use of double trigger,hCG combined with GnRH-a,in high ovarian responders can induce follicle maturation and egg retrieval as well as hCG single trigger,without affecting the fertility treatment outcomes,and is beneficial to reduce the occurence of moderate to severe OHSS.