HCG日不同优势卵泡比例对IVF/ICSI妊娠结局的影响
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摘要
【目的】为摸索适合不同方案最佳人绒毛膜促性腺激素注射日(HCG日)优势卵泡比例,探讨HCG日直径18 mm以上卵泡不同比例在不同方案中对体外受精/单精子卵泡浆内显微注射-胚胎移植(IVF/ICSI-ET)结局的影响,为个体化确定HCG日提供依据。【方法】本研究回顾性分析2014年至2016年长方案IVF/ICSI共3 064周期,拮抗剂方案IVF/ICSI共918周期临床资料。按照HCG日优势卵泡(直径≥18 mm)的不同比例将患者在不同方案中均分成3组:低比例组:优势卵泡比例<20%;中比例组:20%≤优势卵泡比例≤40%;高比例组:优势卵泡比例>40%。分别分析不同方案中不同年龄段,3组患者间基本资料及助孕结局。【结果】≤30岁年龄群患者中,促性腺激素释放激素激动剂(GnRHa)长方案中,成熟卵子率在HCG日优势卵泡比<20%组明显低于另外2组(P <0.05)。临床妊娠率比较3组间无统计学差异。而在拮抗剂方案中,临床妊娠率、中重度卵巢过度刺激综合征(OHSS)发生率在3组间差异无明显统计学意义(P> 0.05)。≥40岁年龄群患者中,长方案中,获卵数在HCG日优势卵泡比<20%组明显高于另外2组,可利用胚胎率最低(P <0.05);可利用胚胎率在HCG日优势卵泡比> 40%组高,但临床妊娠率低于另外2组,但差异无统计学意义。拮抗剂方案中,临床妊娠率在HCG日优势卵泡比<20%组明显高于另外2组,差异具有统计学意义(P <0.05)。两种方案中均无中重度OHSS发生。【结论】在≤30岁患者中无论长方案或拮抗剂方案,随着HCG日优势卵泡比增加可能增加成熟卵子率,但不影响临床结局。而在≥40岁患者中无论长方案或拮抗剂方案,HCG日优势卵泡比例>40%,临床妊娠率明显降低,在拮抗剂方案中将优势卵泡比例控制在20%以内更重要。
【Objective】The aim of this study was to investigate the proportion of dominant follicles(PDF)on HCG day in young and aged women.【Methods】In total,3 064 cycles of GnRH agonist long protocol and 918 cycles of GnRH antagonist protocol from 2014 to 2016 were retrospectively included. Patients were divided into 3 groups(low PDF,< 20%;medium PDF,≥20% and ≤40%;high PDF,> 40%). The measurements regarding the ovarian stimulation characteristics,clinical pregnancy rate was compared between different PDF groups stratified by age and protocol.【Results】In patients aged ≤30 years who received the GnRH agonist long protocol,no significant difference was found in the clinical pregnancy rate between the different PDF groups(P > 0.05). Regarding the GnRH antagonist protocol,no significant difference was found in the clinical pregnancy rate and moderate or severe OHSS rate(P > 0.05). In patients aged ≥40 years,the clinical pregnancy rate in the low PDF group was higher than that in the high PDF groups(40% vs. 30.88%)in GnRH agonist long protocol. Concerning the GnRH antagonist protocol,patients in the low PDF group had a significantly higher clinical pregnancy rate than those in the other two groups(27.27% vs. 9.09%,7.40%;P = 0.002).【Conclusions】PDF within 20% is recommended for older patients(≥40 years),especially in those receiving the GnRH antagonist protocol.
【Objective】The aim of this study was to investigate the proportion of dominant follicles(PDF)on HCG day in young and aged women.【Methods】In total,3 064 cycles of GnRH agonist long protocol and 918 cycles of GnRH antagonist protocol from 2014 to 2016 were retrospectively included. Patients were divided into 3 groups(low PDF,< 20%;medium PDF,≥20% and ≤40%;high PDF,> 40%). The measurements regarding the ovarian stimulation characteristics,clinical pregnancy rate was compared between different PDF groups stratified by age and protocol.【Results】In patients aged ≤30 years who received the GnRH agonist long protocol,no significant difference was found in the clinical pregnancy rate between the different PDF groups(P > 0.05). Regarding the GnRH antagonist protocol,no significant difference was found in the clinical pregnancy rate and moderate or severe OHSS rate(P > 0.05). In patients aged ≥40 years,the clinical pregnancy rate in the low PDF group was higher than that in the high PDF groups(40% vs. 30.88%)in GnRH agonist long protocol. Concerning the GnRH antagonist protocol,patients in the low PDF group had a significantly higher clinical pregnancy rate than those in the other two groups(27.27% vs. 9.09%,7.40%;P = 0.002).【Conclusions】PDF within 20% is recommended for older patients(≥40 years),especially in those receiving the GnRH antagonist protocol.
引文
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[14]Li Y,Yang W,Chen X,et al.Comparison between follicular stimulation and luteal stimulation protocols with clomiphene and HMG in women with poor ovarian response[J].Gynecol Endocrinol,2016,32(1):74-77.
[15]Hu X,Luo Y,Huang K,et al.New perspectives on criteria for the determination of HCG trigger timing in GnRH antagonist cycles[J].Medicine,2016,95(20):e3691.
[16]López Martín MJ,García D,Vassena R,et al.Oocyte developmental Competence is independent of ovarian reserve in women younger than 35 years[J].Reprod Biomed Online,2018,37(6):677-684.
[17]Gallot V,Berwanger da Silva AL,Genro V,et al.Antral follicle responsiveness to follicle-stimulating hormone administration assessed by the Follicular Output RaTe(FORT)may predict in vitro fertilization-embryo transfer outcome[J].Hum Reprod,2012,27(4):1066-1072.
[18]Genro VK,Matte U,De Conto E,et al.Frequent polymorphisms of FSH receptor do not influence antral follicle responsiveness to follicle-stimulating hormone administration as assessed by the Follicular Output RaTe(FORT)[J].J Assist Reprod Genet,2012,29(7):657.
[19]Zhang N,Hao CF,Zhuang LL,et al.Prediction of IVF/ICSI outcome based on the follicular output rate[J].Reprod Biomed Online,2013,27(2):147-153.
[2]Geng Y,Xun Y,Hu S,et al.GnRH antagonist versus follicular-phase single-dose GnRH agonist protocol in patients of normal ovarian responses during controlled ovarian stimulation[J].Gynecol Endocrinol,2018,15:1-5.
[3]Lambalk CB,Banga FR,Huirne JA,et al.GnRHantagonist versus long agonist protocols in IVF:a systematic review and meta-analysis accounting for patient type[J].Hum Reprod Update,2017,23(5):560-579.
[4]Wang R,Lin S,Wang Y,et al.Comparisons of GnRH antagonist protocol versus GnRH agonist long protocol in patients with normal ovarian reserve:A systematic review and meta-analysis[J].PLoS One,2017,12(4):e0175985.
[5]Lin H,Li Y,Li L,et al.Is a GnRH antagonist protocol better in PCOS patients?A meta-analysis of RCTs[J].PloS one,2014,9(3):e91796.
[6]Kahraman S,Cetinkaya CP,Cetinkaya M,et al.The effect of follicle size and homogeneity of follicular development on the morphokinetics of human embryos[J].J Assist Reprod Genet,2017,34(7):895-903.
[7]Ahmadi F,Akhbari F,Zamani M,et al.Value of endometrial echopattern at HCG administration day in predicting IVF outcome[J].Arch Iran Med,2017,20(2):101-104.
[8]Nivet AL,LéveilléMC,Leader A,et al.Transcriptional characteristics of different sized follicles in relation to embryo transferability:potential role of hepatocyte growth factor signalling[J].Mol Hum Reprod,2016,22(7):475-484.
[9]李轶,李瑞岐,区颂邦,等.成熟卵泡比例与HCG注射时机的选择及对卵子发育潜能的影响[J].中山大学学报(医学科学版),2014,35(4):552-558.Li Y,Li RQ,Ou SB,et al.Proportion of dominant follicles as the guidance of HCG triggering and its effect on the oocyte development competence[J].JSun Yat-sen Univ(Med Sci),2014,35(4):552-558.
[10]Kolibianakis EM,Bourgain C,Papanikolaou EG,et al.Prolongation of follicular phase by delaying hCG administration results in a higher incidence of endometrial advancement on the day of oocyte retrieval in GnRH antagonist cycles[J].Hum Reprod,2005,20(9):2453-2456.
[11]Vandekerckhove F,Gerris J,Vansteelandt S,et al.Delaying the oocyte maturation trigger by one day leads to a higher metaphase II oocyte yield in IVF/ICSI:a randomized controlled trial[J].Reprod Biol Endocrinol,2014,12(1):31.
[12]Baerwald AR,Adams GP,Pierson RA.Characterization of ovarian follicular wave dynamics in women[J].Biol Reprod,2003,69(3):1023-1031.
[13]Vegetti W,Alagna F.FSH and folliculogenesis:from physiology to ovarian stimulation[J].Reprod Biomed Online,2006,12(6):684-694.
[14]Li Y,Yang W,Chen X,et al.Comparison between follicular stimulation and luteal stimulation protocols with clomiphene and HMG in women with poor ovarian response[J].Gynecol Endocrinol,2016,32(1):74-77.
[15]Hu X,Luo Y,Huang K,et al.New perspectives on criteria for the determination of HCG trigger timing in GnRH antagonist cycles[J].Medicine,2016,95(20):e3691.
[16]López Martín MJ,García D,Vassena R,et al.Oocyte developmental Competence is independent of ovarian reserve in women younger than 35 years[J].Reprod Biomed Online,2018,37(6):677-684.
[17]Gallot V,Berwanger da Silva AL,Genro V,et al.Antral follicle responsiveness to follicle-stimulating hormone administration assessed by the Follicular Output RaTe(FORT)may predict in vitro fertilization-embryo transfer outcome[J].Hum Reprod,2012,27(4):1066-1072.
[18]Genro VK,Matte U,De Conto E,et al.Frequent polymorphisms of FSH receptor do not influence antral follicle responsiveness to follicle-stimulating hormone administration as assessed by the Follicular Output RaTe(FORT)[J].J Assist Reprod Genet,2012,29(7):657.
[19]Zhang N,Hao CF,Zhuang LL,et al.Prediction of IVF/ICSI outcome based on the follicular output rate[J].Reprod Biomed Online,2013,27(2):147-153.