摘要
目的:比较拮抗剂方案中添加促性腺激素释放激素激动剂(GnRH-a)进行黄体支持对新鲜移植周期临床结局的影响,探讨更合适的黄体支持方案.方法:回顾性分析 2018 年 1 月至 2021 年12 月在本院行体外受精或卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕治疗,采用拮抗剂方案行新鲜周期移植的不孕症患者共674 个周期的临床资料.根据黄体期是否添加GnRH-a进行黄体支持分为对照组和观察组,对照组给予常规的黄体支持,共 348 个周期;观察组在常规黄体支持的基础上,于取卵后多剂量间断给予GnRH-a 0.1 mg,共 326 个周期.比较分析两组患者的一般资料、促排卵情况及临床结局.结果:两组患者间的年龄、不孕年限、体质量指数(BMI)、基础卵泡刺激素(bFSH)、促性腺激素(Gn)天数及总量、绒促性素(HCG)日黄体生成素(LH)、雌二醇(E2)及孕酮(P)、获卵数、MII卵数、优质胚胎数、正常受精率、中重度卵巢过度刺激综合征(OHSS)发生率、流产率、活产率、多胎率、妊娠期并发症发生率、子代的出生体质量、早产率及出生缺陷率等比较差异均无统计学意义(P>0.05);观察组的着床率及临床妊娠率显著高于对照组(P<0.05).多因素Logistic回归分析显示,年龄、移植胚胎数是临床妊娠率的影响因素(OR 0.958,95%CI 0.917～1.000;OR 1.857,95%CI 1.173～2.942).结论:拮抗剂方案新鲜移植周期中,在常规黄体支持基础上,多剂量间断给予短效GnRH-a进行黄体支持可提高患者的着床率及临床妊娠率,可能成为拮抗剂方案新鲜周期移植后较合适的黄体支持方案.
Abstract
Objective:To compare the effect of luteal-phase support administration of gonadotrophin-releasing hormone agonist(GnRH-a)on the outcomes of fresh embryo transfer in GnRH antagonist cycles,and explore a more appropriate protocol of luteal-phase support.Methods:A retrospective analysis was performed on the infer-tility patients who receiving in vitro fertilization or intracytoplasmic sperm injection embryo transfer(IVF/ICSI-ET)in the Reproductive Medicine Center of our hospital from January 2018 to December 2021.Our study collected clini-cal data from 674 cycles of infertility patients undergoing fresh cycle transplantation using antagonist regimens.The patients were divided into the control group(n =348)and the observation group(n =326)according to if Gn-RH-a was added to the luteal phase.The patients in control group were given standard luteal support treatment,while the patients in observation group were given multiple-dose GnRH-a 0.1mg to standard luteal support treat-ment after egg retrieval.The general data,ovulation induction and clinical outcome were compared between the two groups.Results:Between the two groups of patients,there was no statistically significant difference in age,years of infertility,body mass index(BMI),basal follicle stimulating hormone(bFSH),days and total amount of gonadotropin(Gn),chorionic gonadotropin(HCG),luteinizing hormone(LH),estradiol(E2)and progesterone(P),the number of retrieved oocytes,MII oocytes,number of embryos,normal fertilization rate,moderate to se-vere ovarian hyperstimulation syndrome(OHSS)rate,abortion rate,live birth rate,multiple pregnancy rate,inci-dence of pregnancy complications,birth weight of offspring,preterm birth rate,and birth defect rate(P>0.05).The implantation rate and clinical pregnancy rate were significantly higher in the observation group compared with control group(P<0.05).Multivariate Logistic regression analysis indicated that age and number of transferred embryos could influence the clinical pregnancy rate(OR 0.958,95%CI 0.917-1.000;OR 1.857,95%CI 1.173-2.942).Conclusions:In fresh embryo transfer cycles with GnRH antagonist protocol,on the basis of conventional luteal support,multi-dose intermittent short-acting GnRH-a for luteal support can achieve a good clin-ical outcome,and may be a suitable luteal support scheme for GnRH antagonist protocol in fresh embryo transfer cycles.
基金项目
贵州省科技厅基础研究计划([2020]1Y337)
国家科技期刊平台
NSTL
万方数据