摘要
目的探讨在控制性卵巢刺激(COS)拮抗剂方案的高反应周期中,能安全有效地促进卵子成熟的扳机方式。方法回顾性分析2017年1月至2019年6月于中山大学附属第一医院生殖中心行卵胞浆单精子注射(ICSI)受精[包括植入前遗传学检测(PGT)]患者的临床资料。纳入COS拮抗剂方案高反应(扳机日雌二醇,E2>14684.93pmol/L)的334例患者,共345个周期资料,按照扳机方式分为单促性腺激素释放激素激动剂(GnRH-a)扳机组(A组,n=14);GnRH-a+小剂量人绒毛膜促性腺激素(hCG)双扳机组(B组,n=194);重组hCG 250μg扳机组(C组,n=115);hCG 10000U扳机组(D组,n=22)。比较4组的一般资料、COS情况、实验室结果(包括卵子成熟率等)。采用广义估计方程(GEE)校正混杂因素。结果A、B、C、D 4组的中位基础窦卵泡数(AFC)分别为23.5、19.0、16.0、17.0个,A、B两组明显高于C组(P<0.05)。扳机日E2≥18356.17pmol/L的比例A、B、C、D 4组分别为64.3%、64.4%、38.3%、40.9%,A、B两组明显高于C组,B组显著高于D组(P<0.05)。A、B两组的获卵数及成熟卵子数均明显高于C、D两组(中位数分别为获卵数28.0、27.0枚vs.20.0、19.0枚;成熟卵子数23.0、20.5枚vs.16.0、16.0枚,P均<0.05)。中位卵子成熟率A、B、C、D 4组分别为83.26%、83.33%、82.76%、85.36%,差异无统计学意义(P>0.05);GEE校正Gn使用总量、AFC、BMI等混杂因素后,拮抗剂方案高反应周期不同扳机方式卵子成熟率差异无统计学意义(P>0.05)。结论促排卵拮抗剂方案高反应周期,拟行全胚冷冻时,可考虑采用单GnRH-a或GnRH-a联合小剂量hCG双扳机。
Objective To discuss the effective and safe method to promote the final maturation of oocytes in high ovarian response patients under gonadotropin release hormone(GnRH)antagonist protocol.Methods The present retrospective study included 334 women who underwent control ovarian stimulation(COS)with intracytoplasmic sperm injection(ICSI)under GnRH antagonist protocol,including preimplantation genetic testing(PGT),showing a high ovarian response(Estradiol,E2>14684.93 pmol/L on trigger day)in the First Affiliated Hospital of Sun Yat-sen University from January,2017 to June,2019.In total,345 cycles were divided into four groups based on the method for oocytes maturation,including GnRH agonist(GnRH-a)(Group A,n=14),GnRH-a combined with small dose of human chorionic gonadotropin(hCG)(Group B,n=194),recombinant hCG 250μg(Group C,n=115)and hCG 10000 U(Group D,n=22).Compare the difference in general demographic characteristics,COS conditions,and laboratory outcomes,including the maturation rate of oocytes.Confounding factors were corrected by general estimate equation(GEE).Results The median antral follicle count(AFC)in four groups was 23.5,19.0,17.0 and 17.0,respectively,which was higher in Group A and B than in Group C(P<0.05).The ratios of E2≥18356.17 pmol/L on trigger day in four groups-were 64.3%,64.4%,38.3%and 40.9%,respectively,which was significantly higher in Group A and B than in Group C,and Group B higher than Group D(P<0.05).The number of oocytes retrieved and mature oocytes in group A and B were significantly higher than those in group C and D[median oocytes:(28.0,27.0)vs.(20.0,19.0);mature oocytes:(23.0,20.5)vs.(16.0,16.0),respectively,(P<0.05)].The median maturation rate of oocytes of group A,B,C,D was 83.26%,83.33%,82.76%and 85.36%,there being no significant difference among these four groups(P>0.05).After correcting the used dose of gonadotropin(Gn),AFC,and BMI by GEE,there was no significant difference in maturation rate of oocytes with different trigger methods among different groups in high ovarian responders under GnRH antagonist protocol(P>0.05).Conclusion GnRH-a alone or combined with a small dose of hCG trigger may be considered in high ovarian response patients under GnRH antagonist protocol,when"freeze-all"policy is applied.
作者
刘洋
陈明晖
沈晓婷
罗诗琪
徐亚萌
乌日汗
钟依平
LIU Yang;CHEN Ming-hui;SHEN Xiao-ting;LUO Shi-qi;XU Ya-meng;WU Ri-han;ZHONG Yi-ping(Reproductive Medicine Center,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;不详)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2020年第8期762-766,共5页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家自然科学基金青年项目(81601239)。
关键词
控制性促排卵
拮抗剂方案
双板机
单GnRH-a扳机
卵子成熟率
control ovarian stimulation
GnRH antagonist protocol
dual trigger
GnRH-a trigger
maturation rate of oocytes
