拮抗剂方案与黄体期长方案在卵巢正常反应人群中的应用效果比较

Comparison of the efficacy of GnRH antagonist protocol and luteal phase prolonged protocol in patients with normal ovarian response

目的比较拮抗剂方案与黄体期长方案促排卵应用于卵巢正常反应人群的临床结局。方法回顾性分析2022年9月至2023年12月在我院生殖助孕中心使用拮抗剂方案或黄体期长方案促排卵、首次行IVF/ICSI-ET助孕的卵巢正常反应患者的临床资料。根据促排卵方案不同进行分组,并进行倾向得分匹配,匹配后拮抗剂组(采用拮抗剂方案促排卵)和长方案组(采用黄体期长方案促排卵)分别纳入395个周期。比较两组患者的一般资料、促排卵及胚胎发育情况、妊娠结局。结果倾向得分匹配后的拮抗剂组、长方案组的年龄、体质量指数(BMI)、抗苗勒管激素(AMH)等一般资料比较均无显著性差异(P>0.05)。拮抗剂组的Gn总量[(2471.01±583.32)U vs.(2903.93±678.94)U]、HCG日E2水平[(9659.91±4895.58)pmol/L vs.(11410.16±5495.06)pmol/L]显著低于长方案组(P<0.05),HCG日LH水平[(3.07±1.83)U/L vs.(1.49±1.04)U/L]、孕酮水平[(2.70±1.49)nmol/L vs.(2.69±1.75)nmol/L]及D3优胚率(58.23%vs.53.10%)均显著高于长方案组(P<0.05);两组的Gn天数、内膜厚度、中重度卵巢过度刺激综合征(OHSS)发生率、获卵数、总受精率、2PN受精率比较均无显著性差异(P>0.05)。拮抗剂组共移植359个周期,长方案组共移植384个周期,拮抗剂组移植卵裂胚周期占比(9.47%vs.20.05%)显著低于长方案组(P<0.001),移植囊胚周期占比(90.53%vs.79.95%)显著高于长方案组(P<0.001);两组间移植胚胎数、着床率、临床妊娠率、早期流产率、活产率及到达活产时间比较均无显著性差异(P>0.05)。结论拮抗剂方案和黄体期长方案均可用于卵巢正常反应人群,拮抗剂方案中促排卵药物使用剂量更少、D3优胚率也更高,但两种方案首次胚胎移植的妊娠结局尚无明显差异。

Objective:To compare the clinical outcomes of using GnRH antagonist protocol and luteal phase prolonged protocol for controlled ovarian stimulation in patients with normal ovarian response.Methods:A retrospective analysis was conducted on the clinical data of patients with normal ovarian response who used GnRH antagonist protocol or luteal phase prolonged protocol for ovulation induction and underwent the first cycle of IVF/ICSI-ET in Center of Reproductive Assistance in our hospital from September 2022 to December 2023.They were divided into groups according to different ovulation induction programs,and propensity score matching was performed.After matching,395 cycles were included in the GnRH antagonist group with GnRH antagonist protocol and the prolonged protocol group with the luteal phase prolonged protocol.The general characteristics,ovulation induction and embryo development,pregnancy outcomes of the two groups were compared.Results:There were no significant differences in age,body mass index(BMI),anti-Müllerian hormone(AMH)level and other data of basic characteristics between the GnRH antagonist group and the prolonged protocol group after propensity score matching.The total amount of gonadotropin use[(2471.01±583.32)U vs.(2903.93±678.94)U]and estradiol level on the trigger day[(9659.91±4895.58)pmol/L vs.(11410.16±5495.06)pmol/L]in the GnRH antagonist group were significantly lower than those in the prolonged protocol group(P<0.05).The levels of LH[(3.07±1.83)U/L vs.(1.49±1.04)U/L]and progesterone[(2.70±1.49)nmol/L vs.(2.69±1.75)nmol/L]on the trigger day,as well as the high-quality embryo rate(58.23%vs.53.10%)in the GnRH antagonist group were significantly higher than those in the prolonged protocol group(P<0.05).There were no significant differences in the duration of gonadotropin use,endometrial thickness,the incidence of moderate to severe OHSS,the number of oocyte retrieved,total fertilization rate and bi-pronuclear(2PN)fertilization rate between the two groups(P>0.05).There were 359 transplanted cycles in the GnRH antagonist group and 384 transplanted cycles in the prolonged protocol group.The proportion of cleavage stage embryos transferred in the GnRH antagonist group(9.47%vs.20.05%)was significantly lower than that of the prolonged protocol group(P<0.001),while the proportion of blastocyst transferred was significantly higher than that of the prolonged protocol group(90.53%vs.79.95%,P<0.001).There were no significant differences in the number of transferred embryos,the implantation rate,clinical pregnancy rate,early miscarriage rate,live birth rate and time to live birth between the two groups(P>0.05).Conclusions:Both GnRH antagonist protocol and luteal phase prolonged protocol could be used in patients with normal ovarian response.GnRH antagonist protocol had a lower amount of gonadotropin use and a higher high-quality embryo rate,while there are no significant differences in pregnancy outcomes of first ET between the two protocols.