DOR患者自然周期体外受精应用GnRH-a扳机对胚胎实验室技术指标的影响

The effect of natural cycle in vitro fertilization using GnRH⁃a trigger on embryo laboratory technical indicators in DOR patients

目的:研究卵巢储备功能减退(diminished ovarian reserve,DOR)人群自然周期体外受精(in vitro fertilization,IVF)方案中,使用促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRH-a)扳机对胚胎实验室技术指标的影响。方法:回顾性分析2018年1月1日―2023年4月30日在南京医科大学附属妇产医院生殖医学中心行自然周期IVF助孕的DOR患者资料,根据是否使用GnRH-a扳机分为扳机组和未扳机组,扳机组300周期,未扳机组47周期,利用倾向性评分匹配进行1∶3匹配,分析比较两组患者的总获卵数、可移植胚胎数、优质胚胎数、正常受精率、卵子利用率、优质胚胎率和未获卵率的差异。结果:通过倾向性评分匹配后共纳入165周期(未扳机组46周期,扳机组119周期),扳机组优质胚胎率高于未扳机组(61.1%vs. 35.0%,P=0.045),两组总获卵数、可移植胚胎数、优质胚胎数、正常受精率、卵子利用率和未获卵率差异无统计学意义(P均> 0.05)。结论:自然周期使用GnRH-a扳机能提高DOR患者的优质胚胎率。

Objective:To investigate the effect of gonadotropin-releasing hormone agonist(GnRH-a)trigger on the laboratory technical indicators of embryos during natural cycle in vitro fertilization(IVF)in patients with diminished ovarian reserve(DOR).Methods:A retrospective study was conducted to analyze the data of patients with DOR who underwent natural IVF cycles in the Reproductive Medicine Center of the Affiliated Obstetrics and Gynaecology Hospital of Nanjing Medical University from January 1,2018 to April 30,2023.According to whether the GnRH-a trigger was used,the patients were divided into the trigger group and the non-trigger group,with 300 cycles in the trigger group and 47 cycles in the non-trigger group.A 1∶3 propensity score matching(PSM)was performed to compare the total number of oocytes retrieved,transferable embryos,high-quality embryos normal fertilization rate,oocyte utilization rate,high-quality embryos rate,and non-retrieved oocytes rate between the two groups.Results:A total of 165 cycles were included the(46 cycles in the non-trigger group and 119 cycles in the trigger group)after PSM,and the high-quality embryo rate in the trigger group was higher than that in the non-trigger group(61.1%vs.35.0%,P=0.045).There were no significant differences in the total number of oocytes retrieved,the number of transferable embryos,the number of high-quality embryos,the normal fertilization rate,the oocyte utilization rate,and the non-retrieved oocyte rate between the two groups(all P>0.05).Conclusion:The use of GnRH-a trigger during the natural cycle can improve the rate of high-quality embryos in patients with DOR.