3种降调长方案对卵巢储备功能正常不孕患者IVF/ICSI促排卵效果的比较性研究
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摘要
目的:观察3种降调长方案对卵巢储备功能正常不孕患者IVF/ICSI助孕治疗的促排卵效果及临床结局。方法:选取2016年1月至2018年9月于郑州大学第三附属医院生殖医学中心接受长方案IVF/ICSI助孕的卵巢储备正常患者共5846个周期;根据年龄(≤35岁组、>35岁组)分为:短效长方案组(A组)、长效长方案组(B组)和长长方案组(C组),观察不同年龄组3种方案间的实验室及临床的各项指标。结果:年龄≤35岁组和>35岁组中:C组的Gn用量及使用天数、获卵数、ICSI成熟卵数、2PN受精率和优质胚胎率、HCG日P水平和因P值升高行全胚冷冻率均最高,A组最低(P<0.05);A组在Gn启动日及HCG日的LH和E_2水平均高于其他两组(P<0.05),但HCG日内膜厚度最低(P<0.05)。年龄≤35岁组中:B组和C组的着床率和临床妊娠率明显高于A组(P<0.05),B组和C组无明显差异(P>0.05);年龄>35岁组:A、B、C组的着床率和临床妊娠率均无明显差异(P>0.05)。结论:对拟行IVF/ICSI助孕卵巢功能正常的不孕患者:年龄≤35岁者应用长效GnRH-a长方案(长长方案、长效长方案)较短效GnRH-a长方案(短效长方案)更能获得良好的助孕结局;对于年龄>35岁的不孕患者,3种降调长方案的助孕结局无明显差异,短效长方案可明显减少Gn用量及时间。
Objective:To explore the effect of three kinds of down regulation long protocol on ovarian stimulation and clinical outcomes on infertile IVF/ICSI patients with normal ovarian function at different ages.Methods:The data of 5846 IVF/ICSI cycles of infertile patients with normal ovarian function were analyzed from Jan.2016 to Sep.2018 in the reproductive center of the Third Affiliated Hospital of Zhengzhou University.Adjusted by age ≤35 group and>35 group,the patients were divided into short-acting long protocol(group A),long-acting long protocol(group B) and prolonged protocol(group C),the laboratory and clinical related indicators were compared among three kinds of down regulation long protocol in different age groups.Results:In the laboratory observation indicators,regardless of age ≤35 years old or age >35 years old group:C group in Gn dosage and duration,the number of retrieved oocytes,number of maturation oocytes in ICSI cycles,2 PN rate,top-quality embryo rate,the levels of P on HCG day and embryo frozen rate as result from P elevation was the highest and the lowest in the group A(P<0.05).The levels of LH and E_2 on Gn start-up day HCG day in group A were higher than those in other two groups(P<0.05),but the intimal thickness of HCG day was the lowest(P<0.05).In the implantation rate and clinical pregnancy rate,the group C and group B were higher and the lowest in the group A(≤35 years old)(P<0.05).However,the implantation rate and clinical pregnancy rate had no significant differences between three long protocols(>35 years old)(P>0.05).Conclusions:Infertile patients with normal ovarian function underwent in IVF/ICSI cycles:For patients(≤35 years old),long-term GnRH-a regimen(long-term regimen,long-term regimen) is more effective than short-term GnRH-a regimen(short-term regimen) in obtaining better pregnancy outcome.For patients(>35 years old),there is no difference in clinical outcomes between three kinds of down regulation long protocol.But short-acting GnRH-a can reduce dosage and duration of Gn therapy.
Objective:To explore the effect of three kinds of down regulation long protocol on ovarian stimulation and clinical outcomes on infertile IVF/ICSI patients with normal ovarian function at different ages.Methods:The data of 5846 IVF/ICSI cycles of infertile patients with normal ovarian function were analyzed from Jan.2016 to Sep.2018 in the reproductive center of the Third Affiliated Hospital of Zhengzhou University.Adjusted by age ≤35 group and>35 group,the patients were divided into short-acting long protocol(group A),long-acting long protocol(group B) and prolonged protocol(group C),the laboratory and clinical related indicators were compared among three kinds of down regulation long protocol in different age groups.Results:In the laboratory observation indicators,regardless of age ≤35 years old or age >35 years old group:C group in Gn dosage and duration,the number of retrieved oocytes,number of maturation oocytes in ICSI cycles,2 PN rate,top-quality embryo rate,the levels of P on HCG day and embryo frozen rate as result from P elevation was the highest and the lowest in the group A(P<0.05).The levels of LH and E_2 on Gn start-up day HCG day in group A were higher than those in other two groups(P<0.05),but the intimal thickness of HCG day was the lowest(P<0.05).In the implantation rate and clinical pregnancy rate,the group C and group B were higher and the lowest in the group A(≤35 years old)(P<0.05).However,the implantation rate and clinical pregnancy rate had no significant differences between three long protocols(>35 years old)(P>0.05).Conclusions:Infertile patients with normal ovarian function underwent in IVF/ICSI cycles:For patients(≤35 years old),long-term GnRH-a regimen(long-term regimen,long-term regimen) is more effective than short-term GnRH-a regimen(short-term regimen) in obtaining better pregnancy outcome.For patients(>35 years old),there is no difference in clinical outcomes between three kinds of down regulation long protocol.But short-acting GnRH-a can reduce dosage and duration of Gn therapy.
引文
[1] 丰程文,樊桂玲,樊艳玲,等.长效及短效GnRH激动剂长方案临床应用比较[J].中国妇幼保健,2018,33(24):5906-5908
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[4] 韩笑,陈圆辉,徐晓航,等.卵泡期长效长方案在卵巢储备良好但前次黄体期短效长方案助孕失败患者中的应用:一项自身对照研究[J].生殖与避孕,2016,36(10):792-796
[5] 刘景瑜,孙海翔.长效和短效促性腺激素释放激素激动剂在垂体降调中的应用[J].生殖医学杂志,2011,20(1):26-28
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[7] Ren J,Sha A,Han D,et al.Does prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improve the live-birth rate in invitro fertilization treatment?[J].Fertil Steril,2014,102(1):75-81
[8] Mao GH,Feng Z,He Y,et al.Comparisons of the effects of long-acting and short-acting GnRH agonists on embryo quality,endometrial thickness and pregnancy rate in human in vitro fertilization[J].Arch Med Sci,2014,10(1):161-166
[9] 胡琳莉,代玮,孙莹璞.长效/短效GnRH激动剂长方案分别用于卵泡期/黄体期的临床效果比较[J].生殖医学杂志,2016,25(10):919-925
[10] Smitz J,Andersen AN,Devroey P,et al.Endocrine profile in serum and follicular fluid differs after ovarian stimulation with HP-hMG or recombinant FSH in IVF patients[J].Hum Reprod,2007,22(3):676-687
[11] 孙丽君,赵贝,胡继军,等.三种促排卵方案在体外受精/卵泡质内单精子注射卵巢低反应患者中的应用[J].中华生殖与避孕杂志,2018,38(3):186-191
[12] 聂玲,伍琼芳,张寅,等.超长方案在卵巢储备良好前次IVF/ICSI-ET失败患者中的应用分析[J].现代妇产科进展,2011,20(6):470-472
[13] 杨硕,李蓉,甄秀梅,等.促性腺激素释放激素激动剂超长方案在反复体外受精失败患者治疗中的应用[J].中华临床医师杂志:电子版,2012,6(7):152-154
[14] 张帆.卵泡期长效长方案与黄体期短效长方案在卵巢储备良好患者IVF-ET中的应用比较[J].中国优生与遗传杂志,2019,27(2):245-246
[2] Siristatidis CS,Gibreel A,Basios G,et al.Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction[J].Cochrane Database Systematic Rev,2015,11(8):1305-1305
[3] Shen SY,Ma PC,Hsu MI,et al.Prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improve the clinical pregnancy rate in intrauterine insemination treatment[J].Fertil Steril,2014,102(3):e303
[4] 韩笑,陈圆辉,徐晓航,等.卵泡期长效长方案在卵巢储备良好但前次黄体期短效长方案助孕失败患者中的应用:一项自身对照研究[J].生殖与避孕,2016,36(10):792-796
[5] 刘景瑜,孙海翔.长效和短效促性腺激素释放激素激动剂在垂体降调中的应用[J].生殖医学杂志,2011,20(1):26-28
[6] Albuquerque LE,Tso LO,Saconato H,et al.Depot versus daily administration of gonadotrophin-releasinghormone agonist protocols for pituitary down regulation inassisted reproduction cycles[J].Cochrane Database Syst Rev,2013,31(1):CD002808
[7] Ren J,Sha A,Han D,et al.Does prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improve the live-birth rate in invitro fertilization treatment?[J].Fertil Steril,2014,102(1):75-81
[8] Mao GH,Feng Z,He Y,et al.Comparisons of the effects of long-acting and short-acting GnRH agonists on embryo quality,endometrial thickness and pregnancy rate in human in vitro fertilization[J].Arch Med Sci,2014,10(1):161-166
[9] 胡琳莉,代玮,孙莹璞.长效/短效GnRH激动剂长方案分别用于卵泡期/黄体期的临床效果比较[J].生殖医学杂志,2016,25(10):919-925
[10] Smitz J,Andersen AN,Devroey P,et al.Endocrine profile in serum and follicular fluid differs after ovarian stimulation with HP-hMG or recombinant FSH in IVF patients[J].Hum Reprod,2007,22(3):676-687
[11] 孙丽君,赵贝,胡继军,等.三种促排卵方案在体外受精/卵泡质内单精子注射卵巢低反应患者中的应用[J].中华生殖与避孕杂志,2018,38(3):186-191
[12] 聂玲,伍琼芳,张寅,等.超长方案在卵巢储备良好前次IVF/ICSI-ET失败患者中的应用分析[J].现代妇产科进展,2011,20(6):470-472
[13] 杨硕,李蓉,甄秀梅,等.促性腺激素释放激素激动剂超长方案在反复体外受精失败患者治疗中的应用[J].中华临床医师杂志:电子版,2012,6(7):152-154
[14] 张帆.卵泡期长效长方案与黄体期短效长方案在卵巢储备良好患者IVF-ET中的应用比较[J].中国优生与遗传杂志,2019,27(2):245-246