激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响

doi:10.6040/j.issn.1671-7554.0.2020.1671

摘要/Abstract

摘要： 目的探讨控制性超促排卵(COH)周期中,促性腺激素(Gn )的使用天数对卵巢反应良好者的获卵数量、胚胎发育情况以及妊娠结局的影响,并探讨导致Gn使用时间延长的可能影响因素。方法将3 054例行体外受精-胚胎移植(IVF-ET)助孕患者按照Gn刺激时长分成A、B、C 3组(A组:Gn天数≤7 d;B组:8 d≤Gn天数≤10 d;C组:Gn天数≥11 d),比较3组患者的基础资料、COH资料、妊娠结局等情况。采用Logistic多因素回归分析导致Gn刺激时间延长的因素。结果 C组的体质量指数(BMI)及卵泡刺激素(FSH)水平在3组中最高(P=0.001),抗缪勒管激素(AMH)及窦卵泡计数(AFC)水平在3组中最低(P值分别为0.022,0.002);A组Gn启动剂量、Gn总剂量、降调节天数在3组中最少(P值均<0.001)。3组的COH治疗及鲜胚移植周期妊娠结局相关指标差异无统计学意义(P分别为0.86、0.57、0.91、0.64)。多分类Logistics回归分析结果显示,较高的BMI、Gn启动剂量为Gn使用时间延长的危险因素,较高的AMH和AFC、较低的FSH水平和较短的降调节天数是Gn使用时间延长的保护性因素(P<0.001)。结论 Gn使用天数对IVF-ET妊娠结局无明显影响,较高的BMI、Gn启动剂量会明显延长Gn使用时间,而较高的AMH和AFC、较低的FSH水平和较短的降调节天数可缩短Gn使用时间。

关键词: 激动剂长方案, 促性腺激素使用天数, 体外受精-胚胎移植, 妊娠结局

Abstract: Objective To investigate the effect of the duration of gonadotropin(Gn)in the controlled ovarian hyper stimulation(COH)cycle on the number of eggs obtained, embryo development, and pregnancy outcome in those with good ovarian response, and to analyze the possible factors that contributed to the prolongation of Gn use. Methods A total of 3 054 patients undergoing in vitro fertilization-embryo transfer(IVF-ET)were divided into groups A, B, and C according to the days of Gn use(group A: Gn days≤7 d; group B: 8 d ≤Gn days ≤11 d; group C: Gn days ≥12 d).The baseline data, COH and pregnancy outcomes were compared. The possible factors leading to the prolongation of Gn use were analyzed with Logistics regression. Results The highest BMI and FSH levels were found in group C(P=0.001), while the lowest AMH and AFC levels were found in group C(P=0.022, 0.002). The Gn starting dose, total Gn dose and downregulation days in group A were the least among the three groups(P<0.001). There were no significant differences among the three groups in indicators related to COH treatment and pregnancy outcomes(P=0.86, 0.57, 0.91, 0.64). Logistics regression showed that higher BMI and Gn starting dose were risk factors of prolonged Gn use, while higher AMH and AFC, lower FSH level and shorter downregulation days were protective factors of prolonged Gn use. Conclusion The duration of Gn use has no significant effect on the pregnancy outcomes of IVF-ET. Higher BMI and Gn starting dose can significantly prolong Gn use, while higher AMH and AFC, lower FSH level and shorter downregulation days can significantly shorten Gn use.

Key words: Long GnRHa protocol, Usage days of gonadotropin, In vitro fertilization and embryo transfer(IVF-ET), Pregnancy outcome

中图分类号:

R711.6

邬晓琳,李萍. 激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响[J]. 山东大学学报 (医学版), 2021, 59(7): 32-37.

WU Xiaolin, LI Ping. Effect of Gn stimulation duration on pregnancy outcome of IVF-ET in long GnRHa protocol[J]. Journal of Shandong University (Health Sciences), 2021, 59(7): 32-37.

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