Gn累积使用时间和使用量对后续冻融周期临床结局的影响
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摘要
目的:探讨辅助生殖技术促排卵过程中累积促性腺激素(Gonadotropin,Gn)用量和促排时间对后续冻融胚胎移植(FET)周期妊娠结局的影响。方法:回顾性收集2016年10月1日至2017年11月31日在空军军医大学唐都医院妇产科生殖医学中心行FET周期资料,共计1923个FET周期纳入研究。根据促排卵过程中Gn促排时间不同,将研究对象分为3组:(Ⅰ组:Gn促排时间<10天,223个周期;Ⅱ组:10天≤Gn促排时间<15天,1468个周期;Ⅲ组:Gn促排时间≥15天,232个周期)。采用单因素和多因素Logistic分析方法探讨Gn累积用量对着床率、临床妊娠率、早期流产率、异位妊娠率和继续妊娠率的影响。结果:单因素和多因素分析结果显示,着床率、临床妊娠率、早期流产率、异位妊娠率以及继续妊娠率不同Gn促排时间组比较,差异无统计学意义(P>0. 05)。进一步分析各组Gn用量和促排时间对结局交互作用影响,结果显示Gn促排时间≥15天,且Gn累积用量≥40支时,FET周期的胚胎着床率(β-0. 12,95%CI-0. 24,0. 001,P=0. 04)和临床妊娠率(OR 0. 41,95%CI 0. 21,0. 80,P=0. 01)显著下降。结论:促排卵过程中Gn使用具有累积效应,当Gn使用时长小于15天时,Gn使用并不影响后续冻融胚胎妊娠结局,而当Gn使用时长超过15天,Gn累积用量超过40支(≥3000 U)可能降低后续FET周期的着床率和临床妊娠率。
Objective: To study the impact of duration and accumulative dosage of gonadotropin on the pregnancy outcomes after subsequent freeze-thawed embryo transfer cycles( FET). Methods: The data was retrospectively collected from the database of Reproductive Medicine Center of the Tangdu Hospital,the Air Force Military Medical University from October 1st,2016 to November 31 st,2017.A total of 1923 FET cases were analyzed for inclusion.According to the length of stimulation period of Gn,the cohort was categorized into three groups( group Ⅰ: Day<10,n=223; group Ⅱ: 10≤Day<15,n=1468; group Ⅲ: Day≥15,n=232).Univariate and multivariate logistic regression models were used to assess the association of accumulated period of COH on implantation rate,clinical pregnancy rate,early abortion rate,ectopic pregnancy rate and ongoing pregnancy rate in FET cycle.Results: Univariate and multivariate logistic regression models showed that,between the three groups,there was no significant differences( P > 0. 05) in the implantation rate,clinical pregnancy rate,abortion rate,ectopic pregnancy rate and ongoing pregnancy rate.After analysis of interact effect of accumulative dosage of Gn in each groups,it showed that implantation rate( β-0. 12,95%CI-0. 24,0. 001,P = 0. 04) and clinical pregnancy rate( OR 0. 41,95%CI 0. 21,0. 80,P=0. 01) decreased in group C when dosage of Gn was more than 3000 U,and the difference was statistically significant( P <0. 05). Conclusions: During COH cycle,the implantation rate and clinical pregnancy rate in the subsequent FET cycles may decreased when the accumulative time more than 15 days and the accumulative dosage of Gn more than 3000 U.
Objective: To study the impact of duration and accumulative dosage of gonadotropin on the pregnancy outcomes after subsequent freeze-thawed embryo transfer cycles( FET). Methods: The data was retrospectively collected from the database of Reproductive Medicine Center of the Tangdu Hospital,the Air Force Military Medical University from October 1st,2016 to November 31 st,2017.A total of 1923 FET cases were analyzed for inclusion.According to the length of stimulation period of Gn,the cohort was categorized into three groups( group Ⅰ: Day<10,n=223; group Ⅱ: 10≤Day<15,n=1468; group Ⅲ: Day≥15,n=232).Univariate and multivariate logistic regression models were used to assess the association of accumulated period of COH on implantation rate,clinical pregnancy rate,early abortion rate,ectopic pregnancy rate and ongoing pregnancy rate in FET cycle.Results: Univariate and multivariate logistic regression models showed that,between the three groups,there was no significant differences( P > 0. 05) in the implantation rate,clinical pregnancy rate,abortion rate,ectopic pregnancy rate and ongoing pregnancy rate.After analysis of interact effect of accumulative dosage of Gn in each groups,it showed that implantation rate( β-0. 12,95%CI-0. 24,0. 001,P = 0. 04) and clinical pregnancy rate( OR 0. 41,95%CI 0. 21,0. 80,P=0. 01) decreased in group C when dosage of Gn was more than 3000 U,and the difference was statistically significant( P <0. 05). Conclusions: During COH cycle,the implantation rate and clinical pregnancy rate in the subsequent FET cycles may decreased when the accumulative time more than 15 days and the accumulative dosage of Gn more than 3000 U.
引文
[1]Vaughan DA,Leung A,Resetkova N,et al.How many oocytes are optimal to achieve multiple live births with one stimulation cycle?The one and done approach[J].Fertil Steril,2017,107(2):397-404.
[2]Munch EM,Sparks AE,Zimmerman MB,et al.High FSH dosing is associated with reduced live birth rate in fresh but not subsequent frozen embryo transfers[J].Hum Reprod,2017,32(7):1402-1409.
[3]马媛,李懋,梁新新,等.不同位置子宫内膜息肉TCRP术后对IVF/ICSI妊娠结局的影响[J].生殖医学杂志,2017:26(12):1206-1211.
[4]周晶,李博,陈书强,等.冻融胚胎与新鲜胚胎移植的新生儿结局比较[J].生殖医学杂志,2017:26(1):9-13.
[5]中华医学会生殖医学分会第一届实验室学组.人类体外受精-胚胎移植实验室操作专家共识(2016)[J].生殖医学杂志,2017:26(1):1-8.
[6]Balaban B,Brison D,Calderón G,et al.The Istanbul consensus workshop on embryo assessment:proceedings of an expert meeting[J].Hum Reprod,2011,26(6):1270-1283.
[7]刘闯,罗亚宁,李丽,等.冻融周期与新鲜周期囊胚移植的临床结局分析[J].中国实用妇科与产科杂志,2013,29(8):671-674.
[8]Zegers-Hochschild F,Adamson GD,Mouzon JD,et al.International Committee for Monitoring Assisted Reproductive Technology(IC-MART)and the World Health Organization(WHO)revised glossary of ART terminology,2009[J].Fertility&Sterility,2009:92(5):1520-1524
[9]Check JH.Mild ovarian stimulation[J].J J Assist Reprod Genet,2007,24(12):621-627.
[10]Sekhon L,Shaia K,Santistevan A,et al.The cumulative dose of gonadotropins used for controlled ovarian stimulation does not influence the odds of embryonic aneuploidy in patients with normal ovarian response[J].J Assist Reprod Genet,2017,34(6):749-758.
[11]Chuang M,Zapantis A,Taylor M,et al.Prolonged gonadotropin stimulation is associated with decreased ART success[J].J Assist Reprod Genet,2010,27(12):711-717.
[2]Munch EM,Sparks AE,Zimmerman MB,et al.High FSH dosing is associated with reduced live birth rate in fresh but not subsequent frozen embryo transfers[J].Hum Reprod,2017,32(7):1402-1409.
[3]马媛,李懋,梁新新,等.不同位置子宫内膜息肉TCRP术后对IVF/ICSI妊娠结局的影响[J].生殖医学杂志,2017:26(12):1206-1211.
[4]周晶,李博,陈书强,等.冻融胚胎与新鲜胚胎移植的新生儿结局比较[J].生殖医学杂志,2017:26(1):9-13.
[5]中华医学会生殖医学分会第一届实验室学组.人类体外受精-胚胎移植实验室操作专家共识(2016)[J].生殖医学杂志,2017:26(1):1-8.
[6]Balaban B,Brison D,Calderón G,et al.The Istanbul consensus workshop on embryo assessment:proceedings of an expert meeting[J].Hum Reprod,2011,26(6):1270-1283.
[7]刘闯,罗亚宁,李丽,等.冻融周期与新鲜周期囊胚移植的临床结局分析[J].中国实用妇科与产科杂志,2013,29(8):671-674.
[8]Zegers-Hochschild F,Adamson GD,Mouzon JD,et al.International Committee for Monitoring Assisted Reproductive Technology(IC-MART)and the World Health Organization(WHO)revised glossary of ART terminology,2009[J].Fertility&Sterility,2009:92(5):1520-1524
[9]Check JH.Mild ovarian stimulation[J].J J Assist Reprod Genet,2007,24(12):621-627.
[10]Sekhon L,Shaia K,Santistevan A,et al.The cumulative dose of gonadotropins used for controlled ovarian stimulation does not influence the odds of embryonic aneuploidy in patients with normal ovarian response[J].J Assist Reprod Genet,2017,34(6):749-758.
[11]Chuang M,Zapantis A,Taylor M,et al.Prolonged gonadotropin stimulation is associated with decreased ART success[J].J Assist Reprod Genet,2010,27(12):711-717.