促性腺激素释放激素拮抗剂方案中废弃胚胎发育潜能及其与妊娠结局的关系

目的探讨促性腺激素释放激素拮抗剂（GnRH—ant）方案中废弃胚胎的发育潜能，及其与妊娠结局之间的关系。方法体外受精／卵胞浆内单精子注射（IVF／ICSI）患者共76例：促性腺激素释放激素激动剂（GnRH—a）长方案47例，为A组，拮抗剂方案29例，为B组。收集D3胚胎移植、冷冻后剩余低质量废弃胚胎共274枚（包括异常受精胚胎），序贯法囊胚培养（A组有囊胚形成者为A1组，无囊胚形成者为A2组；B组有囊胚形成为B1组，无囊胚形成为B2组），观察囊胚形成情况及妊娠结局，探讨两者之间的关系。结果两组患者基本情况及周期特点无明显差异；促排卵天数及取卵日内膜厚度A组明显大于B组（P〈0．01）。囊胚形成率A组与B组无明显差异（P〉0．05）；总生化妊娠率A组高于B组（P〈0．05）；总临床妊娠率A组显著高于B组（P〈0．01）；生化及临床妊娠率A1组均高于B1组。A1组生化及临床妊娠率均高于A2组（P〈0．05），B1、B2组妊娠率无显著差异（P〉O．05）。结论部分废弃胚胎具有一定的发育潜能，小部分能发育至囊胚阶段，与GnRH—a相比，拮抗剂不影响其发育潜能；常规GnRH—a长方案废弃胚胎发育潜能与妊娠结局显著相关；与GnRH—a长方案相比拮抗剂方案妊娠率有下降，可能与胚胎发育潜能关系不大，其原因需进一步研究。

The developmental potential of discarded embryos collected from GnRH antagonist ovarian stimulation protocols and its correlation with pregnancy outcome

Objective： To explore the developmental potential of discarded embryos collected from GnRH antagonist ovarian stimulation protocols, and its correlation with the pregnancy outcome. Methods： A total of 76 patients undergoing in vitro fertilization/intracytoplasmic sperm injection （IVF/ICSI） cycle （group A： 47 patients with GnRH-agonist ovarian stimulation protocols; group B： 29 patients with GnRH-antagonist ovarian stimulation protocols） were investigated. Two hundreds and seventy four discarded embryos （including abnormally fertilized embryos） collected from these patients were cultured to allow blastula formation, which resulted in 4 subgroups （group A1. patients with blastocyst formation in group A1 group A2. patients without blastocyst formation in group A; group BI： patients with blastocyst formation in group B; group B2： patients with blastocyst formation in group B）. The blastula formation and the pregnancy outcome in different groups were observed and compared. Results. The patientsp condition and clinical characteristics in the two groups were similar. The thickness of endometrium in group A was thicker than in group B at the day of oocytes retrieved. The duration of stimulation in group A was shorter than in group B （P〈0.01）. The blastula formation rate was similar between group A and B （P〉0.05）.Biochemic pregnancy rate of group A was higher than that of group B （P〈0.05）. The clinical pregnancy rate of group A was significantly higher than that of group B （P〈0.01）. Biochemical pregnancy rate and clinical pregnancy rate of group A1 were higher than those of group B1 or A2 （P〈0.05）. The pregnancy rates of group B1 and B2 were similar （P〉0.05）. Conclusions： The discarded embryos had developmental potential at different degrees. GnRHantagonist had no additional effect on the development potential of discarded embryos over GnRH-agonist. The developmental potential of discarded embryo was significantly associated with successful pregnancy outcome in GnRH-agonist ovarian stimulation protocols. The pregnancy rate of GnRH-antagonist ovarian stimulation protocols was lower than that of GnRH-agonist protocols. The reasons need further investigation.