来曲唑联合拮抗剂方案对波塞冬标准下非预期低预后人群新鲜周期促排结局的影响

Effect of combination of letrozole and antagonist regimens on outcome of ovulation induction in patients with unanticipated low prognosis under Poseidon standard

目的探索在拮抗剂方案中添加来曲唑对符合波塞冬分类标准“非预期低预后”人群促排结局的影响。方法本研究回顾性分析2017年1月至2019年12月期间就诊于河南省人民医院生殖中心,满足波塞冬分类标准非预期低预后患者的体外受精/卵胞浆内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)资料共188周期,根据有无在拮抗剂方案中联合应用来曲唑进行分组,拮抗剂方案联合应用来曲唑者为观察组(n=74),未用来曲唑者为对照组(n=114),比较两组患者的一般资料、促排卵结局和妊娠结局。结果两组患者的基础资料未见明显差异(P>0.05);观察组的促性腺激素(gonadotropin,Gn)用量显著低于对照组[(1896.40±701.47)vs(2032.98±760.73),P<0.05];观察组的平均获卵数[(9.27±4.32)vs(6.97±3.90),P<0.05]、MII卵数[(7.56±3.82)vs(6.02±3.32),P<0.05]及优质胚胎率(28.89%vs 20.75%,P<0.05)显著高于对照组;两组间中重度卵巢过度刺激综合征发生率、双原核数、D3可利用胚胎数、无可移植胚胎周期取消率、临床妊娠率、早期流产率、活产率比较均无明显差异(P>0.05)。结论来曲唑联合应用拮抗剂方案用于波塞冬标准非预期低预后患者,可增加平均获卵数和MII卵数,提高优质胚胎率,减少Gn用量,但对新鲜移植周期妊娠结局可能有不利影响。

Objective To explore the effect of adding letrozole to an antagonist regimen on the outcome of ovulation induction in a population meeting the classification criteria of Poseidon for“unexpected low prognosis”.Methods This study retrospectively analyzed the in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)data of patients who visited the Reproductive Center of Henan Provincial People's Hospital from January 2017 to December 2019 and met the Poseidon classification criteria for unexpected low prognosis for a total of 188 cycles.The patients were divided into observation group(n=74)treated with antagonist regimen combined with letrozole and control group(n=114)not treated with letrozole according to the presence or absence of letrozole in the antagonist regimen.The general data,ovulation induction outcomes and pregnancy outcomes were compared between the two groups.Results No significant difference was observed in the basic data between the two groups(P>0.05);Gn consumption in the observation group was significantly lower than that of the control group[(1896.40±701.47)vs(2032.98±760.73),P<0.05];the mean number of oocytes retrieved[(9.27±4.32)vs(6.97±3.90),P<0.05],number of metaphase II(MII)[(7.56±3.82)vs(6.02±3.32),P<0.05],and high-quality embryo rate(28.89%vs 20.75%,P<0.05)in the observation group were significantly higher than those of the control group;there were no significant differences in the incidence of moderate to severe ovarian hyperstimulation syndrome,the number of 2 pronuclear,the number of D3 available embryos,the cancellation rate of cycles without transferable embryos,the clinical pregnancy rate,the early abortion rate,and the live birth rate between the two groups(P>0.05).Conclusion Letrozole combined with antagonist regimen in patients with unexpected low prognosis of Poseidon criteria can increase the average number of oocytes retrieved and MII eggs,increase the rate of high-quality embryos,and reduce the dosage of Gn,but it may adversely affect pregnancy outcomes in fresh transplant cycles.