早卵泡期长效长方案促排卵过程中内源性黄体生成素升高后拮抗剂的应用对临床结局的影响

Clinical outcomes of the antagonists use for endogenous luteinizing hormone elevation during ovulation induction in early follicular phase long protocol

目的:探讨早卵泡期长效长方案控制性促排卵过程中出现内源性黄体生成素(LH)升高后拮抗剂的应用对新鲜周期移植临床结局的影响。方法:回顾性分析2016年9月至2022年12月于河南省人民医院生殖医学中心行体外受精/卵胞浆内单精子注射-胚胎移植助孕的早卵泡期长效长方案出现内源性LH升高的240个周期,根据是否添加拮抗剂分为两组,并采用倾向性评分匹配进行1∶1匹配,最终纳入194个周期,其中A组(添加拮抗剂)97个周期,B组(未添加拮抗剂)97个周期。比较两组患者促排卵过程中相关临床指标及新鲜周期移植临床结局的差异。结果:A组Gn应用时间、Gn启动日LH、 hCG前日LH水平、成熟卵数均高于B组,但hCG日LH水平低于B组(P<0.05)。A、B组平均移植胚胎数、卵裂期胚胎移植占比、临床妊娠率、异位妊娠率及活产率差异无统计学意义(P>0.05)。结论:早卵泡期长效长方案控制性促排卵出现内源性LH升高时添加拮抗剂可以有效抑制LH水平,获得较为理想的临床结局。

Aim:To investigate the effects of the antagonists on clinical outcomes of fresh cycle transplantation after endogenous luteinizing hormone(LH)elevation during ovulation induction in early follicular phase long protocol.Methods:A retrospective analysis was performed on 240 cycles undergoing in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)embryo transfer treatment with early follicular phase long protocol and endogenous LH elevation during ovulation induction in the Reproductive Medical Center of Henan Provincial People′s Hospital from September 2016 to December 2022.They were allocated into 2 groups according whether antagonists were added,and 1∶1 matching was performed by propensity score matching:group A(added antagonists)97 cycles,group B(no antagonists added)97 cycles.The differences between the 2 groups in the clinical indicators during ovulation induction and clinical outcomes of fresh cycle transplantation were compared.Results:The duration of Gn used,LH on Gn start day,LH on the day before hCG day,and number.of MⅡoocytes in group A were significantly higher than those in group B,while LH on hCG day in group A was significantly lower than that in group B(P<0.05).There were no statistical differences in the average number of transplanted embryos,proportion of cleavage embryo transfer,clinical pregnancy rate,ectopic pregnancy rate or live birth rate between the 2 groups(P>0.05).Conclusion:Addition of the antagonists when endogenous LH is elevated during ovulation induction in the early follicular phase long protocol can effectively inhibit the level of LH,and improve the clinical outcomes of fresh cycles.