卵巢正常反应人群行拮抗剂方案取消移植的原因分析及对策研究

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摘要目的探讨卵巢正常反应人群行拮抗剂方案新鲜周期移植率低的原因和策略。方法采用回顾性病例对照研究,分析2015年7月1日—2017年6月30日在第九○○医院生殖医学中心采用拮抗剂灵活方案超促排卵并取卵的不孕症患者的临床资料,以同期激动剂方案为对照组;拮抗剂方案根据新鲜周期胚胎移植情况进一步分为新鲜周期移植和晚卵泡期孕酮升高取消移植两个亚组。主要观察指标为促性腺激素(Gn) 使用情况、超促排卵过程性激素变化、获卵数、优质胚胎数、新鲜周期移植取消原因及取消率、累积活产率等。结果两方案患者的Gn总量、获卵数、优胚数、优质囊胚形成数、每取卵周期的累积活产率差异无统计学意义。两方案新鲜周期移植的临床妊娠率、流产率、宫外孕率等差异无统计学意义。拮抗剂方案新鲜周期移植取消率36.1%,高于激动剂方案的18.7%,差异有统计学意义;晚卵泡期孕酮升高是拮抗剂方案新鲜周期移植取消的最主要原因,占比明显高于激动剂方案,差异有统计学意义。拮抗剂方案新鲜周期因晚卵泡期孕酮升高取消移植82例,与该方案新鲜移植周期228例两亚组比较发现,经雌二醇预处理,晚卵泡期孕酮升高取消移植亚组Gn启动日血清雌二醇更低、血清LH较高;更早添加拮抗剂,添加拮抗剂日卵泡数更多、孕酮更高;扳机日血清雌二醇、孕酮更高,获合格卵数更多,差异有统计学意义;但两亚组Gn总量、Gn总天数、优胚数、优质囊胚数等差异无统计学意义。结论尽管卵巢正常反应人群拮抗剂方案新鲜周期移植取消率高于激动剂方案,但两方案每取卵周期累积活产率接近。晚卵泡期孕酮升高是拮抗剂方案新鲜周期移植取消率较高的最主要因素。雌激素预处理反应不良可能是拮抗剂方案晚卵泡期孕酮升高的主要原因。

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	王锦华
	刘芸
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	毛丽华
	陈国勇
	王彩霞
	徐红妹
	何凌云

关键词 ： GnRH拮抗剂方案, GnRH激动剂方案, 新鲜周期移植取消率, 孕酮, 雌激素

Abstract：Objective To explore the reasons and strategies for the low rate of fresh-cycle transplantation with antagonist regimen among women with normal ovarian response.Methods A retrospective case-control study was conducted, infertile patients who were underwent controlled ovarian hyperstimulation and oocyte-retrieval by antagonist or agonist protocol in the reproductive center of 900 ^thhospital were enrolled. The antagonist group was further divided into fresh embryo transfer sub-group and elevated progesterone sub-group. The clinical and laboratory status including total dosesδlength of Gn,high-quality embryo,the cumulative live birth rate per cycle,the cancellation rate and reason of embryo transfer(ET) were compared.Results There was no significant difference in the total amount of Gn, the status of induced ovulation and embryo development,and the cumulative live birth rate per cycle. There was no significant difference in clinical pregnancy rate, abortion rate, ectopic pregnancy rate. The cancellation rate of embryo transfer was 36.1%, which was higher than those of agonist protocol (18.7%). The increase of progesterone in late follicular stage was the main reason for the cancellation of fresh cycle transplantation in antagonist regimen, and the proportion was significantly higher than that in agonist regimen. 82 cases in the fresh cycle of antagonist regimen were cancelled due to elevated progesterone in late follicular phase. Compared with 228 cases in the fresh transplantation cycle of this regimen, it was found that after estradiol pretreatment, the serum estradiol was lower and the serum LH was higher in the group of cancellation of progesterone in late follicular phase; When antagonists were added earlier, the number of follicles and progesterone were higher on the day of adding antagonists; On the trigger day, serum estradiol and progesterone were higher, and the number of qualified eggs was more, the difference was statistically significant; However, there was no significant difference in the total amount of GN, total days of GN, number of excellent embryos and number of high-quality blastocysts between the two subgroups.Conclusion Although the cancellation rate of fresh cycle transfer of antagonist protocol was higher than that of agonist protocol among women with normal ovarian response, the cumulative live birth rate of each oocyte retrieval cycle is close. The increase of progesterone in late follicular phase was the main factor for the high cancellation rate of fresh embryo transplantation with antagonist protocol. The adverse response of estrogen pretreatment may be the main reason for the increase of progesterone in late follicular phase.

Key words： GnRH antagonist protocol GnRH agonist protocol Reason for cancellation of fresh embryo transfer Progesterone Estrogen

收稿日期: 2021-03-01

通讯作者: 刘芸(liuyunfj@126.com)

作者简介: ^▲共同第一作者

引用本文:

王锦华, 刘芸, 黄吴键, 毛丽华, 陈国勇, 王彩霞, 徐红妹, 何凌云. 卵巢正常反应人群行拮抗剂方案取消移植的原因分析及对策研究[J]. 中国生育健康杂志, 2021, 32(6): 524-530. WANG Jinhua, LIU Yun, HUANG Wujian, MAO Lihua, CHEN Guoyong, WANG Caixia, XU Hongmei, HE Lingyun. Analysis on the reasons and strategies of cancellation transplantation during GnRH antagonist protocol among women with normal ovarian response. Chinese Journal of Reproductive Health, 2021, 32(6): 524-530.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2021/V32/I6/524

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