拮抗剂方案用于前次IVF/ICSI-ET失败卵巢储备功能减退患者的自身对照研究

GnRH antagonist protocol in diminished ovarian reserve patients with previous failed IVF/ICSI-ET cycle:a self-controlled study

目的探讨拮抗剂方案用于前一周期激动剂方案促排卵助孕失败的卵巢储备功能减退(DOR)不孕症患者的临床结局。方法回顾性分析2019年1月至2023年6月在我院生殖医学中心接受IVF/ICSI-ET治疗的69例DOR患者的临床资料,第一周期使用激动剂方案(包括黄体期长方案或卵泡期长方案)促排卵助孕失败,第二周期改用拮抗剂方案促排卵。采用自身对照的研究方法比较前后两个周期的助孕结局。结果前后两个周期间的Gn天数、Gn总量、扳机日E 2及P水平、扳机日子宫内膜厚度、扳机日直径≥14 mm卵泡数比较均无显著性差异(P>0.05)。第二周期的扳机日LH水平显著高于第一周期[(2.42±1.83)U/L vs.(1.77±1.40)U/L,P<0.05];第二周期的获卵数[(6.80±3.56)枚vs.(5.45±3.83)枚]、MⅡ卵数[(5.59±3.15)枚vs.(3.91±3.48)枚]、受精率(76.03%vs.61.87%)、2PN率(67.97%vs.53.07%)、D3优质胚胎数[(2.61±2.40)枚vs.(1.25±1.57)枚]及囊胚形成率(44.44%vs.33.56%)均显著高于第一周期(P<0.05);前后两周期的2PN卵裂率、优质囊胚形成率比较无显著性差异(P>0.05)。前后两周期的周期取消率和鲜胚移植异位妊娠率比较无显著性差异(P>0.05);第二周期鲜胚移植的HCG阳性率(45.65%vs.18.18%)和临床妊娠率(36.96%vs.12.73%)显著高于第一周期(P<0.05),流产率显著低于第一周期(11.76%vs.85.71%,P<0.05)。结论对于第一周期使用激动剂方案促排卵助孕失败的DOR患者,第二周期采用拮抗剂方案促排卵可以提高获卵数和优质胚胎数,有利于改善患者的临床结局。

Objective:To explore the clinical outcomes of GnRH antagonist protocol in diminished ovarian reserve(DOR)patients who failed to get pregnancy in their first cycle of IVF/ICSI-ET with GnRH agonist(GnRH-a)protocols.Methods:The clinical data of 69 DOR patients who failed to get pregnancy with GnRH-a protocols(including luteal-phase and follicular-phase GnRH-a protocols)at the first cycle,and then used GnRH antagonist protocol in the second cycle in the Reproductive Medical Center of Renmin Hospital of Wuhan University from January 2019 to June 2023 were analyzed retrospectively.The self-controlled analysis was used to compare the clinical outcomes of the two cycles.Results:There were no significant differences in the duration of gonadotropin(Gn)use,total Gn,estradiol(E 2)and progesterone(P)levels on trigger day,endometrial thickness on trigger day,and the number of follicles with diameter≥14 mm on trigger day between the two cycles(P>0.05).The LH level on trigger day of the second cycle was significantly higher than that of the first cycle[(2.42±1.83)vs.(1.77±1.40)U/L,P<0.05].The number of oocytes obtained[(6.80±3.56)vs.(5.45±3.83)],MⅡoocytes[(5.59±3.15)vs.(3.91±3.48)],the fertilization rate(76.03%vs.61.87%),2PN rate(67.97%vs.53.07%),D3 high-quality embryos[(2.61±2.40)vs.(1.25±1.57)],and blastocyst formation rate(44.44%vs.33.56%)in the second cycle were significantly higher than those in the first cycle(P<0.05).There were no significant differences in 2PN cleavage rate and high-quality blastocyst formation rate between the two cycles(P>0.05).There were no significant differences in the cancellation rate and ectopic pregnancy rate of fresh embryo transfer between the two cycles(P>0.05).The HCG positive rate(45.65%vs.18.18%)and clinical pregnancy rate(36.96%vs.12.73%)of fresh embryo transfer in the second cycle were significantly higher than those in the first cycle(P<0.05),and the abortion rate was significantly lower than that in the first cycle(11.76%vs.85.71%,P<0.05).Conclusions:For DOR patients who failed to use the GnRH-a regimen for ovulation induction in the first cycle,using the antagonist regimen for ovulation induction in the second cycle can increase the number of retrieved oocytes and high-quality embryos,which is beneficial to improving the clinical outcomes.