摘要
目的:探讨卵巢储备功能下降(DOR)患者行体外受精/卵胞浆内单精子注射胚胎移植(IVF/ICSI-ET)治疗中使用改良长方案的临床效果。方法:回顾性分析2016年7月-2020年12月本院行IVF/ICSI的DOR患者2299例,分为改良长方案组及拮抗剂组。将年龄、不孕年限、体质指数(BMI)、基础卵泡刺激素(FSH)、窦卵泡数(AFC)及抗缪勒管激素(AMH)纳入匹配变量,通过1:1倾向性评分匹配(PSM)使两组基本情况达到匹配,匹配后各组595例纳入分析,比较两组促排卵情况、实验室数据及临床结局。通过logistic多因素回归分析方法分析不同卵巢刺激方案对每新鲜移植周期活产率的影响。结果:与拮抗剂组相比,改良长方案组除促性腺激素(Gn)启动剂量减少外,Gn天数、Gn总量、人绒毛膜促性腺激素(hCG)日内膜厚度、获卵数、成熟卵数、可利用胚胎数、优质胚胎数、移植囊胚率、临床妊娠率及每新鲜移植周期活产率均显著增高(P<0.05),移植胚胎数及早期流产率无差异(P>0.05)。多因素回归分析显示,年龄、卵巢刺激方案、优质胚胎数及移植胚胎数为每新鲜移植周期活产率的独立影响因素(P<0.05),改良长方案组的活产率显著高于拮抗剂方案组(OR=2.154,95%CI 1.489~3.116)。结论:改良长方案可改善DOR患者新鲜胚胎移植的活产率,可作为DOR患者的卵巢刺激方案的选择之一。
Objective: To evaluate the clinical effect of modified long-acting GnRH agonist protocol during in vitro fertilization-embryo transfer(IVF-ET)/intracytoplasmic sperm injection(ICSI) of the patients with decreased ovarian reserve(DOR). Methods: 2299 patients with DOR who had undergone IVF/ICSI from July 2016 to December 2020 were analyzed retrospectively, which included the patients with modified long-acting GnRH agonist protocol treatment in group A and the patients with antagonist treatment in group B. The age, the duration of infertility, the value of body mass index(BMI),the level of baseline follicle-stimulating hormone(FSH),the antral follicle count(AFC), and the level of anti-Mullerian hormone(AMH) of the patients were included in matching variables, and 1:1 propensity score matching(PSM) was used to matching the basic information of the patient in the two groups(only 595 cases in each group in the end). The situation of ovulation induction, the laboratory data values, and the clinical outcomes of the patient were compared between the two groups. Logistic multifactor regression analysis was used to analyze the influence of different ovarian stimulation protocols of the patients on their live birth rate in each fresh transplantation cycle. Results: The starting dose of reduction gonadotropin(Gn) of the patients in group A was significantly lower than that of the patients in group B, and the days of Gn used, the total dose of Gn used, the thickness of endometrium on the day of human chorionic gonadotropin(hCG) used, the number egg obtained, the number of mature egg, the number of available embryos,the number of high quality embryo,the rate of blastocyst transplantation,the clinical pregnancy rate,and the live birth rate of each fresh transplantation cycle of the patients in group A were significantly higher than those of the patients in group B(P<0.05).There were no significant differences in the number of transplanted embryos and the abortion rate during the first trimester of pregnancy of the patients betwe
作者
孙晶雪
刘伟
郭岩文
郑娟
任建枝
SUN Jingxue;LIU Wei;GUO Yanwen;ZHENG Juan;REN Jianzhi(rd Hospital of PLA,Xiamen,Fujian Province,361000)
出处
《中国计划生育学杂志》
2022年第5期1003-1008,共6页
Chinese Journal of Family Planning
基金
厦门市医学优势亚专科建设项目(厦卫科教[2018]296号文)。
关键词
卵巢储备功能下降
体外受精-胚胎移植
改良长方案
拮抗剂方案
Decreased ovarian reserve
In vitro fertilization-embryo transfer
Modified long acting GnRH agonist pro-tocol
Antagonist Protocol
