低剂量GnRH激动剂长方案和GnRH拮抗剂方案在卵巢储备功能低下患者中的应用比较

目的比较低剂量的GnRH激动剂(GnRH-a)长方案和GnRH拮抗剂(GnRH-ant)方案在卵巢储备功能低下(DOR)患者中的应用效果,以期为此类患者选择更合适的促排卵方案提供参考。方法根据纳入标准和排除标准,收集2018年1月至2019年6月在本院辅助生殖中心进行IVF/ICSI治疗的患者资料进行回顾性分析。按照促排卵方案的不同分为GnRH-ant方案(GnRH-ant组,91个周期)和低剂量GnRH-a长方案(GnRH-a组,147个周期),比较两组的胚胎发育情况和临床妊娠情况;各组再根据年龄分为两个亚组,分别是GnRH-ant年轻组(≤35岁)、GnRH-ant年长组(>35岁)、GnRH-a年轻组(≤35岁)和GnRH-a年长组(>35岁),进行比较分析。结果(1)不同促排卵方案分组比较:两组患者一般情况比较无统计学差异(P>0.05),GnRH-ant组的Gn用量和促排时间均显著低于GnRH-a组(P<0.05),两组间获卵数、受精率、优胚率和囊胚形成率、种植率、临床妊娠率、流产率及活产率均无统计学差异(P>0.05),但GnRH-ant组囊胚形成率略高(33.0%vs 25.2%,P>0.05)。(2)不同方案内年龄亚组比较:GnRH-ant年轻组获卵数显著高于年长组(P<0.05),年轻组受精率、临床妊娠率和活产率略高于年长组,但均无统计学差异(P均>0.05);GnRH-a年轻组获卵数显著高于年长组(P<0.05),年轻组受精率、囊胚形成率种植率和活产率略高于年长组,但均无统计学差异(P均>0.05),但年轻组临床妊娠率显著高于年长组(57.1%vs.30.8%,P<0.05)。(3)跨方案同年龄组比较:GnRH-ant年轻组囊胚形成率略高于GnRH-a年轻组,而种植率、临床妊娠率和活产率均略低于GnRH-a年轻组,但均无统计学差异(P均>0.05);GnRH-ant年长组受精率显著低于GnRH-a年长组(P<0.05),而囊胚形成率和临床妊娠率均略高于GnRH-a年长组,但均无统计学差异(P均>0.05)。结论对于DOR患者,应用GnRH-ant能够达到与低剂量GnRH-a相似的临床结局,且拮抗剂方案的Gn量和Gn天数更少。

Comparison of low dose GnRH agonist long protocol and GnRH antagonist protocol in patients with diminished ovarian reserve

Objective:To compare the effect of low dose GnRH agonist(GnRH-a)long protocol and GnRH antagonist(GnRH-ant)protocol in patients with diminished ovarian reserve(DOR).Methods:According to the inclusion and exclusion criteria,the data of IVF/ICSI patients in our assisted reproductive center from January 2018 to June 2019 were collected for retrospective analysis.According to the ovulation induction protocol,the patients were divided into GnRH-ant group(91 cycles)and low dose GnRH-a group(147 cycles).The embryo development and clinical pregnancy outcome of the two groups were compared.Then,the patients were divided into four subgroups:GnRH-ant young group(<35 years),GnRH-ant old group(>35 years),GnRH-a young group(<35 years),GnRH-a old group(>35 years)according to the age of patients.Results:(1)There was no significant difference in general condition between the two groups(P>0.05).The amount and the days of Gn used in GnRH-ant group were significantly lower than those in GnRH-a group(P<0.05).There was no significant difference in the number of oocytes retrieved,fertilization rate,good embryo rate,blastocyst formation rate,clinical pregnancy rate,abortion rate and live rate between the two groups(P>0.05),but the blastocyst formation rate in the GnRH-ant group was slightly higher than that in the low dose GnRH-a group(33.0%vs.25.2%,P>0.05).(2)Comparison of age subgroups in different protocols:in GnRH-ant group,the number of oocytes obtained in young patients was significantly higher than that of old patients(P<0.05).The fertilization rate,clinical pregnancy rate and live rate of young patients were slightly higher than those of old patients,but there was no statistical significance(P>0.05).In GnRH-a group,the number of oocytes obtained in young patients was significantly more than that in old patients(P<0.05).The fertilization rate,blastocyst formation rate,implantation rate and live rate in young patients were slightly higher than those in old patients,but there was no statistical difference(P>0.05).The clinical pregnancy rate in young patients was significantly higher than that in old patients(57.1%vs.30.8%,P<0.05).(3)Comparison of the same age group in the different protocols:the blastocyst formation rate in GnRH-ant young group was slightly higher than that in GnRH-a young group,while the implantation rate,clinical pregnancy rate and live birth rate were slightly lower in the GnRH-ant young group,but all the differences were not statistically significant(P>0.05).The fertilization rate in GnRH-ant old group was significantly lower than that in the GnRH-a old group(P<0.05),but the blastocyst formation rate and clinical pregnancy rate of the GnRH-ant old group were slightly higher in GnRH-a old group,but there was no statistical difference(P>0.05).Conclusions:For DOR patients,GnRH-ant can obtain similar clinical outcomes as low dose GnRH-a,but the dosage and days of Gn in GnRH-ant group are less.