GnRH拮抗剂方案新鲜周期胚胎移植对临床妊娠结局的影响

潘晓琴; 沈丽雯; 朱梦怡

doi:10.16766/j.cnki.issn.1674-4152.003678

GnRH拮抗剂方案新鲜周期胚胎移植对临床妊娠结局的影响

doi: 10.16766/j.cnki.issn.1674-4152.003678

湖州市妇幼保健院生殖医学中心，浙江湖州 313000

基金项目:

浙江省医药卫生科技项目 2022KY368

详细信息

通讯作者:
潘晓琴, E-mail：cunzai1101@163.com

中图分类号: R715
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出版历程
- 收稿日期: 2024-04-28

Effect of fresh embryo transfer on clinical pregnancy outcomes in patients with GnRH antagonist

Reproductive Medicine Center, Huzhou Maternal and Child Health Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的比较GnRH拮抗剂方案新鲜周期和复苏周期胚胎移植的妊娠结局，为拮抗剂方案胚胎移植策略提供依据。方法回顾性分析2017—2022年于湖州市妇幼保健院生殖中心采用拮抗剂方案促排卵的患者，按是否新鲜周期移植分为2组，研究组为新鲜周期移植的患者(197例)，对照组为新鲜周期全胚冷冻且完成首次复苏周期移植的患者(136例)，比较2组妊娠结局的差异。结果单因素分析显示新鲜周期组和复苏周期组临床妊娠率(50.8% vs. 54.4%, P=0.512)、活产率(41.1% vs. 46.3%, P=0.346)比较差异均无统计学意义, 2组卵裂胚、囊胚着床率比较差异均无统计学意义(P＞0.05)。修正Poisson分析显示拮抗剂方案促排卵周期年龄是唯一能同时预测临床妊娠率(RR=0.989, 95% CI：0.981~0.997, P=0.007)和活产率(RR=0.992，95% CI：0.983~0.999，P=0.048)的因素，新鲜周期胚胎移植不是影响临床妊娠率(RR=1.016, 95% CI：0.924~1.118，P=0.742)和活产率(RR=1.020, 95% CI: 0.922~1.128, P=0.700)的因素。结论拮抗剂方案促排周期，年龄是唯一能同时预测临床妊娠率和活产率的重要因素，而新鲜周期移植不影响临床妊娠结局。
- 拮抗剂方案 /
- 新鲜周期 /
- 复苏周期移植 /
- 临床妊娠率 /
- 活产率
Abstract: Objective To compare of clinical outcomes between fresh cycle transfer and first frozen embryo transfer (FET) in patients during controlled ovarian hyperstimulation (COH) with GnRH antagonist protocol, to explore embryo transfer strategies for GnRH antagonist protocol. Methods A retrospective analysis was performed for patients using GnRH antagonist protocol at the Reproductive Medicine Center of Huzhou Maternal and Child Health Hospital, from 2017 to 2022. The patients were divided into two groups based on whether fresh embryos were transferred. Patients in the study group were treated with fresh embryo transfer (n=197), while patients in the control group were those whose whole embryos freezing and completed the first FET (n=136). The differences in pregnancy outcomes between the two groups were compared. Results There were no significant differences in clinical pregnancy rate (CPR, 50.8% vs. 54.4%, P=0.512), and live birth rate (LBR, 41.1% vs. 46.3%, P=0.346)between the fresh embryo transfer group and the frozen embryo transfer group in patients using GnRH antagonist protocol through univariate analysis, and also in the implantation rate of cleavage embryo and blastocyst (P > 0.05). The age of patients undergoing COH with GnRH antagonist protocol was the only factor predicted both CPR (RR=0.989, 95% CI: 0.981-0.997, P=0.007) and LBR (RR=0.992, 95% CI: 0.983-0.999, P=0.048) through modified Poisson regression. The fresh embryo transfer was not a factor influencing CPR (RR=1.016, 95% CI: 0.924-1.118, P=0.742) and LPR (RR=1.020, 95% CI: 0.922-1.128, P=0.700). Conclusion The age of patients is the only significant predictor of both CPR and LBR using COH with GnRH antagonist protocol, whereas fresh embryo transplantation doses not affect clinical pregnancy outcome.
- GnRH antagonist protocol /
- Fresh transfer /
- Frozen embryo transfer /
- Clinical pregnancy rates /
- Live birth rates
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表 1 拮抗剂方案卵巢刺激周期新鲜周期移植组和复苏周期组基线资料比较

Table 1. Baseline comparison of the GnRH antagonist regimen for ovarian stimulation cycle between the fresh cycle transplantation group and the whole embryo freezing group

项目	新鲜周期组(n=197)	复苏周期组(n=136)	统计量	P值
年龄[M(P₂₅, P₇₅)，岁]	30.0(28.0，34.0)	30.0(27.0，34.0)	1.037^a	0.300
不孕年限[M(P₂₅, P₇₅)，年]	3.0(2.0，5.0)	3.0(1.0，5.0)	0.420^a	0.674
不孕类型[例(%)]			0.401^b	0.527
原发不孕	93(47.2)	69(50.7)
继发不育	104(52.8)	67(49.3)
不孕原因[例(%)]			3.107^b	0.375
女方原因	158(80.2)	110(80.9)
男方原因	19(9.6)	13(9.5)
双方原因	11(5.6)	11(8.1)
不明原因	9(4.6)	2(1.5)
AFC[M(P₂₅, P₇₅)，个]	8.0(7.0，10.0)	10.0(7.0，15.0)	3.016^a	0.003
AMH[M(P₂₅, P₇₅)，ng/nL]	2.50(1.65，4.11)	3.66(2.12，6.50)	4.301^a	＜0.001
bFSH[M(P₂₅, P₇₅)，IU/L]	6.50(5.40，7.60)	6.30(5.40，7.30)	1.427^a	0.154
BMI[M(P₂₅, P₇₅)]	22.3(20.4，24.3)	22.7(20.0，25.0)	0.051^a	0.959
Gn天数[M(P₂₅, P₇₅)，d]	10.0(9.0，11.0)	10.0(9.0，12.0)	3.023^a	0.003
Gn总量[M(P₂₅, P₇₅)，IU]	2 025.0(1 500.0，2 325.0)	2 025.0(1 500.0，2 643.0)	0.994^a	0.320
HCG日LH水平[M(P₂₅, P₇₅)，IU/L]	2.1(1.4，3.3)	2.2(1.3，3.2)	0.676^a	0.499
HCG日E2水平[M(P₂₅, P₇₅)，pmol/L]	8 222.0(5 616.5，12 983.0)	13 000.0(8 872.8，20 835.5)	5.916^a	＜0.001
HCG日P水平[M(P₂₅, P₇₅)，nmol/L]	2.2(1.5，3.1)	3.5(2.1，5.2)	6.268^a	＜0.001
卵巢刺激周期HCG日子宫内膜厚度[M(P₂₅, P₇₅)]	10.0(8.0，11.0)	10.0(9.0，11.0)	2.276^a	0.023
获卵数[M(P₂₅, P₇₅)，个]	8.0(5.0，11.0)	11.0(7.0，16.0)	4.438^a	＜0.001
2PN数[M(P₂₅, P₇₅)，个]	5.0(3.0，7.0)	7.0(4.0，9.3)	3.640^a	＜0.001
D3可利用胚胎数[M(P₂₅, P₇₅)，个]	3.0(2.0，5.0)	4.0(2.0，6.0)	2.936^a	0.003
冷冻胚胎数[M(P₂₅, P₇₅)，个]	1.0(0.0，2.0)	3.0(2.0，5.0)	10.071^a	＜0.001
注：^a为Z值，^b为χ²值。

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表 2 拮抗剂方案新鲜周期组与复苏周期组妊娠结局比较

Table 2. Comparison of pregnancy outcomes between the fresh cycle group and the resuscitation cycle group with GnRH antagonist regimen

项目	新鲜周期组(n=197)	复苏周期组(n=136)	统计量	P值
移植周期子宫内膜厚度[M(P₂₅, P₇₅)，mm]	10.0(8.0，11.0)	10.0(9.0，11.0)	1.474^a	0.140
移植胚胎个数[例(%)]			6.497^b	0.011
1	85(43.1)	78(57.4)
2	112(56.9)	58(42.6)
胚胎类型[例(%)]			59.684^b	＜0.001
卵裂胚	164(83.2)	58(42.6)
囊胚	33(16.8)	78(57.4)
卵裂胚着床[例(%)]			0.757^b	0.685
0.0%	83(50.6)	33(56.9)
50.0%	48(29.3)	14(24.1)
100.0%	33(20.1)	11(19.0)
囊胚着床率[例(%)]			0.867^b	0.648
0.0%	14(42.4)	29(37.2)
50.0%	2(6.1)	9(11.5)
100.0%	17(51.5)	40(51.3)
生化妊娠[例(%)]	100(50.8)	79(58.1)	1.737^b	0.187
临床妊娠[例(%)]	100(50.8)	74(54.4)	0.430^b	0.512
异位妊娠[例(%)]	4(4.0)	0	1.510^b	0.219
双胎妊娠[例(%)]	15(15.0)	6(8.1)	1.903^b	0.168
流产[例(%)]	15(15.0)	11(14.9)	0.001^b	0.980
活产[例(%)]	81(41.1)	63(46.3)	0.889^b	0.346
注：^a为Z值，^b为χ²值。

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表 3 拮抗剂方案临床妊娠率影响因素的修正Poisson分析

Table 3. Modified Poisson analysis of factors influencing clinical pregnancy rate with antagonist regimen

变量	RR(95% CI)	P值
年龄	0.989(0.981~0.997)	0.007
周期类型
新鲜周期	Reference
复苏周期	1.016(0.924~1.118)	0.742
AMH	0.992(0.976~1.010)	0.385
AFC	1.009(0.996~1.023)	0.166
新鲜周期Gn天数	0.982(0.968~0.997)	0.020
新鲜周期HCG日E2水平	1.000(1.000~1.000)	0.632
新鲜周期HCG日P水平	0.981(0.961~1.001)	0.064
获卵数	0.993(0.978~1.009)	0.385
2PN数	1.013(0.992~1.034)	0.220
D3可移植胚胎数	0.992(0.968~1.016)	0.509
冷冻胚胎数	0.996(0.965~1.028)	0.806
移植周期子宫内膜厚度	1.000(0.982~1.019)	0.995
移植胚胎个数
移植1个胚胎	Reference
移植2个胚胎	1.073(0.987~1.167)	0.099
移植胚胎类型
卵裂胚	Reference
囊胚	1.139(1.035~1.254)	0.008

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表 4 拮抗剂方案活产率影响因素的修正Poisson分析

Table 4. Poisson analysis of the modified live birth rate associated with the GnRH antagonist regimen

变量	RR(95% CI)	P值
年龄	0.992(0.983~0.999)	0.048
周期类型
新鲜周期	Reference
复苏周期	1.020(0.922~1.128)	0.700
AMH	0.987(0.969~1.006)	0.170
AFC	1.007(0.993~1.022)	0.303
新鲜周期Gn天数	0.987(0.971~1.004)	0.133
新鲜周期HCG日E2水平	1.000(1.000~1.000)	0.261
新鲜周期P水平	0.982(0.962~1.003)	0.092
获卵数	0.996(0.980~1.030)	0.564
2PN数	1.007(0.984~1.030)	0.564
D3可利用胚胎数	0.991(0.965~1.018)	0.507
冷冻胚胎数	1.007(0.973~1.042)	0.703
子宫内膜厚度	1.009(0.989~1.029)	0.388
移植胚胎个数
移植1个胚胎	Reference
移植2个胚胎	1.073(0.982~1.174)	0.119
移植胚胎类型
卵裂胚	Reference
囊胚	1.077(0.970~1.195)	0.164

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