摘要
目的探讨正常反应人群拮抗剂方案临床妊娠结局及影响因素。方法检索本院生殖中心临床辅助生殖技术管理系统软件(CCRM)数据库,收集2015年1月—2016年1月期间进行体外受精-胚胎移植(IVF-ET)共1 264例采用激动剂长方案(长方案组)与拮抗剂方案(拮抗剂组)超促排卵患者的临床资料,回顾性队列研究分析采用2种不同超促排卵方案患者的临床结局,包括胚胎种植率、临床妊娠率、活产率及中重度卵巢过度刺激综合征(OHSS)发生率等;在此基础上,进一步分析拮抗剂方案组获得妊娠与未获得妊娠患者的临床资料,探讨拮抗剂方案与妊娠相关的因素。结果 (1)拮抗剂组与长方案组患者的基础资料差异无统计学意义(P>0.05),胚胎种植率、临床妊娠率、活产率、中重度OHSS发生率组间差异均无统计学意义(P>0.05);然而拮抗剂组在促性腺激素(Gn)使用总量[(1 483.84±453.79)IU]、刺激时间[(9.4±1.5)d]、hCG注射日雌激素水平[(15 321.29±7 272.67)pmol/L]显著低于长方案组[(1 616.10±490.04)IU、(9.7±1.6)d、(17 293.82±7 690.00)pmol/L,P<0.001],h CG注射日LH水平[(4.28±2.28)IU/L]及孕激素水平[(3.16±2.64)pmol/L]显著高于长方案组[(3.78±1.74)IU/L,(2.51±1.33)pmol/L,P<0.001];(2)比较拮抗剂组新鲜周期移植妊娠与未获得妊娠患者临床资料,妊娠组hCG注射日LH水平[(3.49±2.47)IU/L]显著高于未妊娠组[(2.80±1.82)IU/L,P<0.05],进一步根据h CG注射日LH水平分为LH<2 IU/L组及LH≥2 IU/L两组,显示LH≥2 IU/L组的种植率(47.78%)、临床妊娠率(63.72%)及活产率(58.41%)显著高于LH<2 IU/L组(31.51%、45.45%、36.36%,P<0.05),但Gn的用药时间[(9.1±1.4)d]、拮抗剂的用量[(1.17±0.23)mg]及用药时间[(4.7±0.9)d]、获卵数[(7.5±3.2)d]显著少于LH<2 IU/L组[(9.7±1.5)d、(1.26±0.31)mg、(5.1±1.2)d、(8.6±3.0)d,P<0.05]。结论正常反应人群,较长方案刺激排卵,拮抗剂方案更加温和、友好、高效,有效降低患者Gn用药�
Objective To investigate the clinical pregnancy outcome and influencing factor of the antagonist protocol in normal responders. Methods From January 2015 to January 2016, 1 264 cases of good- prognosis patients with GnRH agonist long protocol and antagonist protocol in in-vitro fertilization and embryo transfer （IVF-ET） were collected using the clinical assisted reproductive technologies management system software （CCRM） database of the Reproductive Medicine Center of Jiangsu Province Hospital. Patients were divided into agonist long protocol and antagnist protocol groups. The clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, clinical pregnancy rate, live birth rate and the incidence of severe ovary hypersitmulation syndrome （OHSS）; on this basis, to explore the factors associated with pregnancy, clinical data of pregnant and non pregnant patients in the antagonist group were further analyzed. Results 1） Comparing antagonist group and agonist long protocol group, the based data did not exhibit remarkable difference, and there was no signifant difference in implantation rate, clinical pregnancy rate, the live birth rate and severe hyperstimulation rate （P〉0.05）. However, the dosage of gonatrophin （Gn） used [（1 483.84±453.79） IU], days of stimulation [（9.4±1.5） d] and estrogen （E：） level [（15 321.29±272.67） pmol/L] on the day of hCG injection in antagonist group were significantly less than agonist long protocol group [（1 616.10±490.04） IU, （9.7±1.6） d, （17 293.82±7 690.00） pmol/L, P〈0.001 ], luteinizing hormone （LH）[（4.28±2.28） 1U/L] and progesterone （P） levels [（3.16±2.64） pmol/L] on the day of hCG injection were significantly higher compared with the agonist long protocol [（3.78±1.74） IU/L, （2.51±1.33） pmol/L, P〈0.05]. 2） Comparing the clinical data of the pregnant patients and non pregnant patients with fresh transplantation cycle in the antagonist group, LH level [（3
作者
李宣
刘嘉茵
陈文森
丁卫
冒韵东
王媁
黄洁
马翔
Li Xuan;Liu Jiayin;Chen Wensen;Ding Wei;Mao Yundong;Wang Wei;Huang Jie;Ma Xiang(Department of Reproductive Medicine, Office of Infection Management, the First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing 210029, China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2018年第3期219-223,共5页
Chinese Journal of Reproduction and Contraception
基金
国家自然科学基金(81571403)
卫生部行业科研专项(201402004)
江苏省高校优势学科(PAPD)创新团队项目(JX10231802)
江苏省妇幼保健科研项目(F201313)
关键词
长方案
拮抗剂方案
正常反应人群
体外受精-胚胎移植(IVF-ET)
黄体生成素
Agonist long protocol
Antagonist protocol
Normal ovary responders
In-vitro fertilization and embryo transfer （IVF-ET）
Luteinizing hormone （LH）
