激动剂长方案与拮抗剂方案对胚胎整倍体率的影响

目的 探讨促性腺激素释放激素类似物(GnRH-a)的选择对胚胎植入前非整倍体遗传学检测(PGT-A)周期胚胎整倍体率以及临床妊娠率的影响。 方法 选取2017年1月—2020年10月于山东大学生殖医学研究中心进行PGT-A周期的卵巢储备良好的年轻女性为研究对象(共359个周期、1 475个囊胚),根据促排卵方案分为拮抗剂组(n=157)、激动剂组(n=202)。应用单因素分析比较两组的基线参数、促排卵及取卵周期参数,并将差异有统计学意义的参数纳入Logistic回归模型进行多因素分析。其中主要观察指标为胚胎整倍体率,次要指标为临床妊娠率。 结果 单因素分析结果显示,激动剂组与拮抗剂组比较,优质囊胚率(41.4% vs 42.9%, P=0.335)、囊胚整倍体率(56.1% vs 52.6%, P=0.171)、冻融胚胎移植(CET)临床妊娠率(69.2% vs 63.2%, P=0.289)差异均无统计学意义。平衡女方年龄、BMI、MⅡ卵子数、多囊卵巢综合征(PCOS)诊断、促性腺激素(Gn)用量、人体毛绒膜促性腺激素(HCG)用量等参数后,选择GnRH激动剂或拮抗剂进行垂体抑制与胚胎整倍体率及临床妊娠率差异均无统计学意义(P>0.05)。对卵巢储备好的年轻患者而言,其获卵数与胚胎整倍体率差异有统计学意义(P=0.04,OR=1.02,95%CI:1.00~1.04)。 结论 GnRH激动剂长方案和拮抗剂方案的选择不会影响胚胎整倍体率及临床妊娠率。因此在全胚冷冻周期中,对卵巢储备功能正常及卵巢高反应的年轻女性进行卵巢刺激可灵活选用拮抗剂方案和激动剂长方案。

Comparison of the euploidy rate of PGT-A tested embryos between long GnRH agonist and GnRH antagonist protocols

Objective To investigate the use of gonadotropin-releasing hormone(GnRH)analog on embryonic euploidy rate as well as clinical pregnancy rate(CPR)in preimplantation genetic testing for aneuploidy(PGT-A)cycles. Methods From Jan. 2017 to Oct. 2020, young women with good ovarian reserve who underwent PGT-A cycles were selected, including 359 cycles and 1,475 blastocysts. The subjects were divided into the antagonist group(n=157)and agonist group(n=202). The baseline parameters, ovulation induction and ovulation cycle parameters of the two groups were determined with univariate analysis, and parameters with statistically significant differences were included in multivariate Logistic regression analysis. The primary parameter was the euploidy rate, and secondary parameter was CPR. Results No statistically significant differences were found in the good-quality blastocysts rate from meiosis Ⅱ(MⅡ)oocytes(41.4% vs 42.9%, P=0.335), embryonic euploidy rate(56.1% vs 52.6%, P=0.171), and CPR(69.2% vs 63.2%, P=0.289)of cryo-thawed embryo transfer(CET). After female age, body mass index(BMI), number of MⅡ oocytes, polycystic ovarian syndrome(PCOS)diagnosis, dosages of gonadotropins(Gn)and human chorionic gonadotropin(HCG)were adjusted, the selection of GnRH analog to achieve pituitary suppression did not affect the embryonic euploidy rate or CPR(P>0.05). For young patients with good ovarian reserve, there was a low statistically significant association between the number of oocytes retrieved and embryonic euploidy rate(P=0.04, OR=1.02, 95%CI: 1.00-1.04). Conclusion Stimulation with long GnRH agonist protocol and GnRH antagonist protocol results in a fairly similar embryonic euploidy rate and clinical pregnancy rate for young patients with ideal ovarian reserve. The findings support the flexible use of GnRH analogs to optimize treatment for this group of patients.