影响高龄女性拮抗剂方案IVF-ET妊娠结局的多因素分析
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摘要
目的比较应用拮抗剂方案的高龄不孕女性行体外受精-胚胎移植(IVF-ET)后不同临床妊娠结局的影响因素,评估各影响因素对临床妊娠结局的作用。方法回顾性分析2015年1月至2016年12月在广东省妇幼保健院生殖中心行IVF-ET治疗的179例188个IVF-ET治疗周期的高龄不孕妇女的临床资料。按是否临床妊娠分为两组,通过单因素分析研究应用拮抗剂方案的高龄不孕妇女行IVF-ET临床妊娠结局的影响因素。结果 188个治疗周期中临床妊娠56例次(29.79%),未临床妊娠132例次(70.21%),平衡两组女方年龄后,抗苗勒氏激素(AMH)(2.66±2.55ng/mL vs 2.21±1.67ng/mL)、促性腺激素(Gn)启动剂量(260.27±58.15IU vs 272.35±44.26IU)及人绒毛膜促性腺激素(hCG)日促黄体生成素(LH)值(3.39±1.49U/L vs 3.70±2.93U/L)的差异均有统计学意义(t值分别为6.50、-5.53、-9.56,均P<0.05)。结论对应用拮抗剂方案的高龄(38~43岁)不孕妇女的IVF-ET新鲜移植周期临床妊娠结局的预测,AMH较年龄更敏感。hCG日较高的LH水平不利于临床妊娠,必要时增加拮抗剂剂量以降低LH水平。
Objective To investigate the factors related to clinical pregnancy outcomes of in vitro fertilization-embryo transfer(IVFET)with GnRH antagonist(GnRH-ant)protocol in elderly infertile women and to estimate the effect of these factors on clinical outcomes.Methods Retrospective analysis was performed on the clinical,laboratory and follow-up data of 188 cycles in 179 elderly infertile patients who met the inclusion criteria undergoing IVF-ET in reproductive medicine center of Guangdong Women and Children Hospital from January 2015 to December 2016,and the patients were divided into two groups according to clinical pregnancy situation.The factors related to pregnancy outcome were analyzed by univariate methods.Results Among 188 cycles 56 cases(29.79%)had clinical pregnancy and 132 cases(70.21%)had no clinical pregnancy.After balancing the maternal ages of two groups,there were significant differences in anti-Mulerian hormone(AMH)level(2.66±2.55 ng/mL vs 2.21±1.67 ng/mL),Gn starting dose(260.27±58.15 IU vs 272.35±44.26 IU)and LH level of the trigger day(3.39±1.49 U/L vs 3.70±2.93 U/L)between two groups(t value was 6.50,-5.53 and-9.56,respectively,all P<0.05).Conclusion Compared to maternal age,AMH level is the more sensitive indicator to predict clinical pregnancy outcomes of the elderly women(38-43 years old)undergoing IVF-ET with GnRH antprotocol.The higher LH level of the trigger day is negative for clinical pregnancy,and GnRH-ant dose should be increased in order to reduce LH level if necessary.
Objective To investigate the factors related to clinical pregnancy outcomes of in vitro fertilization-embryo transfer(IVFET)with GnRH antagonist(GnRH-ant)protocol in elderly infertile women and to estimate the effect of these factors on clinical outcomes.Methods Retrospective analysis was performed on the clinical,laboratory and follow-up data of 188 cycles in 179 elderly infertile patients who met the inclusion criteria undergoing IVF-ET in reproductive medicine center of Guangdong Women and Children Hospital from January 2015 to December 2016,and the patients were divided into two groups according to clinical pregnancy situation.The factors related to pregnancy outcome were analyzed by univariate methods.Results Among 188 cycles 56 cases(29.79%)had clinical pregnancy and 132 cases(70.21%)had no clinical pregnancy.After balancing the maternal ages of two groups,there were significant differences in anti-Mulerian hormone(AMH)level(2.66±2.55 ng/mL vs 2.21±1.67 ng/mL),Gn starting dose(260.27±58.15 IU vs 272.35±44.26 IU)and LH level of the trigger day(3.39±1.49 U/L vs 3.70±2.93 U/L)between two groups(t value was 6.50,-5.53 and-9.56,respectively,all P<0.05).Conclusion Compared to maternal age,AMH level is the more sensitive indicator to predict clinical pregnancy outcomes of the elderly women(38-43 years old)undergoing IVF-ET with GnRH antprotocol.The higher LH level of the trigger day is negative for clinical pregnancy,and GnRH-ant dose should be increased in order to reduce LH level if necessary.
引文
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[10]La Marca A,Grisendi V,Giulini S,et al.Individualization of the FSH starting dose in IVF/ICSI cycles using the antral follicle count[J].J Ovarian Res,2013,6(1):11.
[11]杨砺娇,陈秀凤,韩晓晴.调经促孕丸结合雌孕激素人工周期治疗DOR不孕症的疗效[J].中国妇幼健康研究,2017,28(8):1017-1019.
[12]Sun W,Liu C,Feng Y,et al.Macrophage colony-stimulating factor(M-CSF)is an intermediate in the process of luteinizing hormone-induced decrease in natriuretic peptide receptor 2(NPR2)and resumption of oocyte meiosis[J].J Ovarian Res,2017,10(1):68.
[2]Schauer C,Tong T,Petitjean H,et al.Hypothalamic gonadotropin-releasing hormone(GnRH)receptor neurons fire in synchrony with the female reproductive cycle[J].J Neurophysiol,2015,114(2):1008-1021.
[3]Schimberni M,Ciardo F,Schimberni M,et al.Short gonadotropin-releasing hormone agonist versus flexible antagonist versus clomiphene citrate regimens in poor responders undergoing in vitro fertilization:a randomized controlled trial[J].Eur Rev Med Pharmacol Sci,2016,20(20):4354-4361.
[4]Figueiredo J B,Nastri C O,Vieira A D,et al.Clomiphene combined with gonadotropins and GnRH antagonist versus conventional controlled ovarian hyperstimulation without clomiphene in women undergoing assisted reproductive techniques:systematic review and meta-analysis[J].Arch Gynecol Obstet,2013,287(4):779-790.
[5]Choux C,Barberet J,Ginod P,et al.Severe ovarian hyperstimulation syndrome modifies early maternal serum betahuman chorionic gonadotropin kinetics,but obstetrical and neonatal outcomes are not impacted[J].Fertil Steril,2017,108(4):650-658.
[6]Arunamata A,Axelrod D M,Bianco K,et al.Chronic antepartum maternal hyperoxygenation in a case of severe fetal Ebstein’s anomaly with circular shunt physiology[J].Ann Pediatr Cardiol,2017,10(3):284-287.
[7]Sighinolfi G,Grisendi V,La Marca A.How to personalize ovarian stimulation in clinical practice[J].J Turk Ger Gynecol Assoc,2017,18(3):148-153.
[8]Aboulghar M,Saber W,Amin Y,et al.Impact of antimüllerian hormone assays on the outcomes of in vitro fertilization:a prospective controlled study[J].Fertil Steril,2014,101(1):134-137.
[9]Arce J C,La Marca A,Mirner Klein B,et al.Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles:prediction of ovarian response and cumulative treatment outcome in good-prognosis patients[J].Fertil Steril,2013,99(6):1644-1653.
[10]La Marca A,Grisendi V,Giulini S,et al.Individualization of the FSH starting dose in IVF/ICSI cycles using the antral follicle count[J].J Ovarian Res,2013,6(1):11.
[11]杨砺娇,陈秀凤,韩晓晴.调经促孕丸结合雌孕激素人工周期治疗DOR不孕症的疗效[J].中国妇幼健康研究,2017,28(8):1017-1019.
[12]Sun W,Liu C,Feng Y,et al.Macrophage colony-stimulating factor(M-CSF)is an intermediate in the process of luteinizing hormone-induced decrease in natriuretic peptide receptor 2(NPR2)and resumption of oocyte meiosis[J].J Ovarian Res,2017,10(1):68.