两种不同西曲瑞克在年轻不孕患者GnRH拮抗剂方案中的应用

Application of two different kinds of Cetrorelix in GnRH antagonist regiments in young infertile patients

目的比较年轻不孕患者在促性腺激素释放激素拮抗剂(GnRH-ant)方案IVF-ET治疗周期中应用两种不同西曲瑞克对临床疗效的影响。方法回顾性分析徐州市妇幼保健院生殖医学科2022年3月至2023年6月收治的年龄<35岁且应用GnRH-ant方案助孕治疗的不孕患者的临床资料,共650个周期。根据使用GnRH-ant的不同种类分为国产西曲瑞克组(国产组,249个周期)和进口西曲瑞克组(进口组,401个周期),比较两组患者的基本资料、促排卵及胚胎实验室指标、临床妊娠结局。结果两组患者的年龄、不孕年限、体质量指数(BMI)、基础性激素及抗苗勒管激素(AMH)水平比较均无显著性差异(P>0.05)。国产组的可利用胚胎数、D3优胚数、D3优胚率、优质囊胚数和优质囊胚率均显著高于进口组(P<0.05);两组间促性腺激素(Gn)总量、Gn天数、扳机日LH、雌二醇(E_(2))及孕酮(P)水平、获卵数、MⅡ卵数、双原核(2PN)卵数、囊胚形成数、扳机日LH升高率、中重度卵巢过度刺激综合征(OHSS)发生率及注射后不良反应发生率比较均无显著性差异(P>0.05)。两组患者均未发生自发排卵。国产组共42个周期进行鲜胚移植,进口组共73个周期进行鲜胚移植,两组间鲜胚移植后HCG阳性率、胚胎种植率、临床妊娠率、多胎率、早期流产率及活产率比较均无显著性差异(P>0.05)。结论年轻患者采用GnRH-ant方案促排卵治疗时应用国产西曲瑞克和进口西曲瑞克可达到相似的抑制排卵效果,均可获得良好的临床妊娠结局,且使用国产西曲瑞克时可利用胚胎数和优质胚胎数更高。

Objective:To compare the clinical efficacy of two different formulations of cetrorelix,a GnRH antagonist(GnRH-ant),in young infertile patients undergoing IVF-ET cycles.Methods:A retrospective analysis was conducted on the clinical data of infertile patients under 35 years old who were treated with the GnRH-ant protocol at the Reproductive Medicine Department of Xuzhou Maternity and Child Health Care Hospital from March 2022 to June 2023.A total of 650 cycles were analyzed.The patients were divided into two groups based on the type of GnRH-ant used:the domestic cetrorelix group(domestic group,249 cycles)and the imported cetrorelix group(imported group,401 cycles).The basic characteristics,ovulation induction and embryo laboratory parameters,and clinical pregnancy outcomes were compared between the two groups.Results:There were no statistically significant differences in the patients’age,duration of infertility,body mass index(BMI),baseline hormone levels,and the level of anti-Müllerian hormone(AMH)between the two groups(P>0.05).The domestic cetrorelix group showed significantly higher embryo yield,number of high-quality embryos on day 3,day 3 high-quality embryo rate as well as a higher number and rate of high-quality blastocyst when compared to the imported cetrorelix group(P<0.05).There were also no significant differences in total dose of gonadotropins(Gn),the duration of Gn administration,levels of LH,estradiol(E_(2)),and progesterone(P)on trigger day,the number of retrieved oocytes,the number of mature(MⅡ)oocytes,the number of 2 pronuclear(2PN)zygotes,the number of blastocyst formed,the proportion of elevated LH levels on trigger day,as well as incidence rates of moderate to severe OHSS and adverse reactions after injection between the two groups(P>0.05).After 42 cycles with fresh embryo transfer in the domestic group and 73 in the imported group,there were no statistically significant differences in HCG positive rate,the implantation rate,clinical pregnancy rate,multiple pregnancy rate,early miscarriage rate,and live birth rate between the two groups(P>0.05).Conclusions:When using the GnRH-ant protocol to induce ovulation in young patients,both domestic and imported cetrorelix can achieve similar ovulation suppression effects as well as good clinical pregnancy outcomes.Moreover,the use of domestic cetrorelix can utilize a higher number of available embryos and high-quality embryos.