南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (3): 412-417.doi: 10.12122/j.issn.1673-4254.2021.03.14

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卵泡发育中晚期添加HMG可改善妊娠结局：基于682例高龄卵巢储备减退患者

吴晓敏，陈映雪，周星宇，张 俊，黎 莹，李 欣，张笑菲，陈士岭
  

  • 出版日期:2021-03-20 发布日期:2021-04-06

Timing of HMG supplementation and clinical outcomes of advanced-age patients with diminished ovarian reserve receiving gonadotropin-releasing hormone antagonist protocol

  • Online:2021-03-20 Published:2021-04-06

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摘要： 目的 探讨促性腺激素释放激素拮抗剂（GnRH-ant）方案中添加人绝经期促性腺激素（HMG）的时机对高龄卵巢储备减退（DOR）不孕患者妊娠结局的影响。方法 行体外受精-胚胎移植（IVF-ET）治疗的≥35岁的DOR患者682例，采用拮抗剂方案，均于月经周期2~3 d启动卵泡刺激素（FSH）促排卵治疗，根据添加HMG的时机分为无添加组371例（不添加HMG）、早期添加组139例（每日加用HMG直至扳机日）、中晚期添加组172例（主导卵泡直径达到10~14 mm时每日加用HMG直至扳机日），比较3组的妊娠结局。结果 3组扳机日雌二醇、孕酮水平、扳机日子宫内膜厚度、扳机日直径≥14、16、18 mm的卵泡个数、受精率、卵裂率差异均无统计学意义（P>0.05），Gn用量早期添加组和中晚期添加组高于无添加组，中晚期添加组获卵数高于早期添加组，成熟卵子数及可利用胚胎数中晚期添加组高于无添加组及早期添加组（P<0.05）。新鲜周期临床妊娠率中晚期添加组高于无添加组（P<0.05），种植率、早期流产率、异位妊娠率、活产率3组差异无统计学意义（P>0.05）。全胚冷冻周期首次移植种植率、临床妊娠率、早期流产率、异位妊娠率、活产率3组差异无统计学意义（P>0.05）。结论 高龄DOR患者应用GnRH-ant方案时，在卵泡发育的中晚期添加HMG能改善促排卵结局和新鲜周期临床妊娠率。

关键词: GnRH拮抗剂方案；人绝经期促性腺激素；高龄；卵巢储备减退

Abstract: Objective To assess the effect and timing of human menopausal gonadotropin (HMG) supplementation in advancedage patients with diminished ovarian reserve (DOR) receiving gonadotropin-releasing hormone antagonist protocol. Methods A total of 682 patients with DOR aged over 35 years undergoing IVF-ET treatment were included in this study. All the patients underwent a GnRH antagonist protocol, and controlled ovarian stimulation was initiated on day 2-3 of the menstrual cycle with follicle stimulation hormone (FSH). According to the timing of HMG supplementation, the patients were divided into no supplementation group (n=371) without HMG supplementation; early supplementation group (n=139), in which daily HMG supplementation started on the first day till the trigger day; and late supplementation group (n=172), in which HMG supplementation started when the leading follicle reached 10-14 mm in diameter and lasted until the trigger day. The pregnancy outcomes of the patients were compared among the 3 groups. Results The 3 groups showed no significant difference in hCG trigger day E2 and P levels, endometrial thickness, or the number of follicles with comparable fertilization rate and cleavage rate (P>0.05). Gn dose used was the lowest in no supplementation group, and the average number of oocytes retrieved was significantly smaller in early supplementation group than in late supplementation group (P<0.05). The mean number of mature oocytes and embryos available were significantly higher in late supplementation group than in early supplementation group (P< 0.05). The clinical pregnancy rate of fresh embryo transfer cycle was significantly higher in late supplementation group than in no supplementation group (27.7% vs 45.1%, P<0.05), but the implantation rate, early miscarriage rate, heterotopic pregnancy rate and live birth rate were comparable among the 3 groups (P>0.05). No significant differences were found among the 3 groups in the implantation rate, clinical pregnancy rate, early miscarriage rate, heterotopic pregnancy rate or live birth rate of the first frozen-thawed embryo transfer cycle with a freeze-all strategy (P>0.05). Conclusions HMG supplementation in the middle and late follicular phase can improve the outcomes of controlled ovarian hyperstimulation and increase the clinical pregnancy rate of fresh embryo transfer cycle in advanced-age patients with DOR undergoing GnRH antagonist protocol.

Key words: gonadotropin-releasing hormone antagonist protocol; human menopausal gonadotropin; advanced age; diminished ovarian reserve