【摘要】 目的比较促性腺激素释放激素拮抗剂(GnRH-ant)的固定方案和灵活方案在不同年龄组患者中行体外受精/单精子胞浆内注射-胚胎移植(IVF/ICSI-ET)新鲜胚胎移植周期的妊娠结局。方法收集采用GnRH-ant方案进行IVF/ICSI-ET者的临床资料,共纳入1 321个周期,根据患者采用的GnRH-ant方案分为固定方案组(1 014个周期)及灵活方案组(307个周期),比较固定方案组和灵活方案组患者的基本资料、促排卵情况、新鲜移植周期的妊娠结局差异,并根据女方年龄分为<35岁、35～39岁、≥40岁,分别比较新鲜周期中不同年龄者行固定方案与灵活方案的妊娠结局差异。最后进行二元Logistic回归分析,分析固定方案组与灵活方案组间的临床妊娠率差异。结果固定方案组和灵活方案组的生化妊娠率、临床妊娠率和种植率比较差异均无统计学意义(P均> 0.05)。固定方案组的获卵数、成熟卵子数和优质胚胎数均多于灵活方案组(P均<0.05)。新鲜周期中年龄<35岁者,固定方案组的Gn总用量低于灵活方案组、HCG注射日雌二醇水平高于灵活方案组、获卵数亦多于灵活方案组(P均<0.05)。二元Logistic回归分析显示年龄(校正后OR=0.961,95%CI 0.927～0.996,P=0.033)和移植胚胎数(校正后OR=1.756,95%CI 1.167～2.642,P=0.012)是临床妊娠率的影响因素,而选择固定方案或灵活方案对临床妊娠率无影响(P> 0.05)。结论 GnRH-ant固定方案和灵活方案的妊娠结局相近。与灵活方案相比,GnRH-ant固定方案组的促排卵时间缩短,获卵数、成熟卵子数和优质胚胎数增加。更多还原

【Abstract】 Objective To compare the pregnancy outcomes between the fixed and flexible gonadotrophin-releasing hormone antagonist(GnRH-ant) protocols for fresh embryo transfer cycles during in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET) in patients of different ages. Methods Clinical data of patients undergoing IVF/ICSI-ET using the GnRH-ant protocol were retrospectively analyzed. Among 1 321 fresh embryo transfer cycles, all patients were assigned into the fixed(1 014 cycles) and flexible GnRH-ant protocol groups(307 cycles). The baseline data, ovulation induction and pregnancy outcomes were statistically compared between two groups. All patients were divided into three subgroups according to age: ≤ 34 years old, 35-39 years old, ≥ 40 years old. The pregnancy outcomes were statistically compared in fixed and flexible GnRH-ant protocol groups of different aged subgroups. The clinical pregnancy rate was compared between the fixed and flexible protocol groups by using binary Logistic regression analysis. Results The biochemical pregnancy rate, clinical pregnancy rate and implantation rate did not significantly differ between the fixed and flexible protocol groups(all P > 0.05). The number of retrieved oocytes, the number of mature oocytes and the number of high-quality embryos in the fixed protocol group were significantly higher than those in the flexible group(all P < 0.05). For patients aged < 35 years old, the total dose of Gn in the fixed protocol group was significantly lower, the estradiol level upon the day of HCG injection was considerably higher and the number of retrieved oocytes was remarkably higher compared with those in the flexible protocol group(all P < 0.05). Binary Logistic regression analysis demonstrated that age(adjusted OR = 0.961, 95% CI 927-0.996, P = 0.033) and the number of transferred embryos(adjusted OR = 1.756, 95% CI 1.167-2.642, P = 0.012) were the influencing factors of the clinical pregnancy rate. The clinical pregnancy rates did not significantly differ between the fixed and flexible protocols(adjusted OR = 1.188, 95% CI 0.755-1.868, P = 0.46). Conclusions The pregnancy outcomes are similar between the fixed and flexible GnRHant protocols in the fresh embryo transfer cycles. Compared with the flexible protocol group, the time of ovulation induction is shortened, and the number of retrieved oocytes, mature oocytes and high-quality embryos is increased in the fixed protocol group.更多还原