外源性药物扳机可改善卵巢功能减退患者自然周期体外受精/卵胞浆内单精子注射助孕的结局：一项倾向性评分匹配及Logistic回归分析

doi:10.12122/j.issn.1673-4254.2025.07.19

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (7): 1519-1526.doi: 10.12122/j.issn.1673-4254.2025.07.19

外源性药物扳机可改善卵巢功能减退患者自然周期体外受精/卵胞浆内单精子注射助孕的结局：一项倾向性评分匹配及Logistic回归分析

常馨月¹^,²(), 姚宁宁³, 赵燕¹^,², 王银凤⁴, 王岸聪¹^,², 张慧辉¹^,², 张静¹^,²^,⁵()

^1.临沂市人民医院，妇产科，山东临沂 276002
^2.临沂市辅助生殖与子代健康重点实验室，山东临沂 276002
^3.临沂市人民医院，生物样本库，山东临沂 276002
^4.菏泽市中医医院生殖医学中心，山东菏泽 274000
^5.临沂市人民医院，中医妇科，山东临沂 276002

收稿日期:2025-05-31 出版日期:2025-07-20 发布日期:2025-07-17
通讯作者: 张静 E-mail:chang_xy@126.com;2253113841@qq.com
作者简介:常馨月，硕士，主治医师，E-mail: chang_xy@126.com
基金资助:
山东省医药卫生科技发展计划项目(202205031123)

Exogenous triggering with hCG/GnRHa improves outcomes of natural cycle IVF/ICSI in patients with diminished ovarian reserve: a propensity score matching and logistic regression analysis

Xinyue CHANG¹^,²(), Ningning YAO³, Yan ZHAO¹^,², Yinfeng WANG⁴, Ancong WANG¹^,², Huihui ZHANG¹^,², Jing ZHANG¹^,²^,⁵()

^1.Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi 276002, China
^2.Key Laboratory for Assisted Reproduction and Offspring Health of Linyi City, Linyi 276002, China
^3.Biobank, Linyi People's Hospital, Linyi 276002, China
^4.Department of Reproductive Medicine, Heze Hospital of Traditional Chinese Medicine, Heze 274000, China
^5.Department of Obstetrics in Traditional Chinese Medicine, Linyi People's Hospital, Linyi 276002, China

Received:2025-05-31 Online:2025-07-20 Published:2025-07-17
Contact: Jing ZHANG E-mail:chang_xy@126.com;2253113841@qq.com

摘要/Abstract

摘要：

目的评估使用外源性药物（hCG/GnRHa）扳机对卵巢储备减退患者自然周期体外受精/卵胞浆内单精子注射（NC-IVF/ICSI）助孕生殖预后的影响。方法回顾性分析2013年1月~2024年1月两家生殖中心的1118个NC-IVF/ICSI周期。采用倾向性评分匹配（PSM）和多因素Logistic回归校正混杂因素，并通过受试者工作特征（ROC）曲线确定扳机日促黄体生成素（LH）阈值。评估指标包括获卵率、2PN受精率、可移植胚胎率、优质胚胎率、新鲜周期临床妊娠率（CPR）及活产率。结果经PSM和Logistic回归校正混杂因素后，外源性扳机组在所有结局指标（获卵率、2PN率、可移植胚胎率、优质胚胎率、鲜胚周期临床妊娠率及活产率）上均优于内源性LH组（P<0.05）。年龄分层分析显示，对于全年龄段患者，外源性扳机策略提高了可利用胚胎率及优质胚胎率（P<0.001）；在35~39岁亚组中，扳机组患者在获卵率、优质胚胎率、CPR及活产率方面均展现出优势（P<0.05），其中活产率的提升尤为明显（OR=6.25，95% CI：1.34~29.23）。ROC分析确立了决策日LH阈值19.055 mIU/mL（AUC=0.945，特异度=93.3%），该阈值可用于指导临床路径的精准分层。结论在卵巢储备减退患者的NC-IVF/ICSI助孕中，采用外源性扳机可全面优化生殖结局，尤其使35~39岁患者获得显著活产获益。依据LH阈值（19.055 mIU/mL）的个体化决策能有效提升胚胎潜能和活产率。

关键词: 卵巢储备减退, 自然周期IVF/ICSI, 促排卵扳机, 黄体生成素阈值, 胚胎质量

Abstract:

Objective To explore the effects of exogenous trigger (hCG/GnRHa) versus endogenous LH surge in natural cycle IVF/ICSI (NC-IVF/ICSI) for patients with diminished ovarian reserve (DOR). Methods A retrospective analysis was conducted on 1,118 NC-IVF/ICSI cycles from two reproductive centers between 2013 and 2024. Propensity score matching (PSM) and multivariate logistic regression were used to adjust for confounding factors. The trigger-day hormone threshold was determined using receiver operating characteristic (ROC) curve analysis. Outcome measures included oocyte retrieval rate, 2PN fertilization rate, clinical available embryo rate, high-quality embryo rate, fresh cycle clinical pregnancy rate (CPR), and live birth rate (LBR). Results After adjusting for confounders via PSM and logistic regression, the exogenous trigger group demonstrated significantly better outcomes across all the evaluated parameters (oocyte retrieval rate, 2PN fertilization rate, transferable embryo rate, high-quality embryo rate, fresh cycle CPR, and LBR) than the endogenous LH surge group (P<0.05). Age-stratified analysis revealed that for the entire cohort, exogenous triggering significantly increased the number of transferable embryos and high-quality embryos (P<0.001). In the 35-39 years old subgroup, exogenous triggering showed significant advantages in oocyte yield, high-quality embryo rate, CPR, and LBR (P<0.05) and resulted in the most pronounced improvement in LBR (OR=6.25, 95% CI: 1.34-29.23). ROC analysis established a decision-day LH threshold of 19.055 mIU/mL (AUC=0.945, specificity=93.3%) for precise stratification of the clinical pathways. Conclusion For DOR patients undergoing NC-IVF/ICSI, exogenous triggering comprehensively improves the treatment outcomes, particularly providing significant live birth benefits for women aged 35-40 years. An individualized protocol incorporating the LH threshold (19.055 mIU/mL) effectively enhances embryonic developmental potential and live birth rates.

Key words: diminished ovarian reserve, natural cycle IVF/ICSI, ovulation trigger, luteinizing hormone threshold, embryo quality

常馨月, 姚宁宁, 赵燕, 王银凤, 王岸聪, 张慧辉, 张静. 外源性药物扳机可改善卵巢功能减退患者自然周期体外受精/卵胞浆内单精子注射助孕的结局：一项倾向性评分匹配及Logistic回归分析[J]. 南方医科大学学报, 2025, 45(7): 1519-1526.

Xinyue CHANG, Ningning YAO, Yan ZHAO, Yinfeng WANG, Ancong WANG, Huihui ZHANG, Jing ZHANG. Exogenous triggering with hCG/GnRHa improves outcomes of natural cycle IVF/ICSI in patients with diminished ovarian reserve: a propensity score matching and logistic regression analysis[J]. Journal of Southern Medical University, 2025, 45(7): 1519-1526.

图/表 6

参考文献 26

[1]	Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo[J]. Lancet, 1978, 312(8085): 366. doi：10.1016/s0140-6736(78)92957-4
[2]	Baker VL, Dyer S, Chambers GM, et al. International committee for monitoring assisted reproductive technologies (ICMART): world report for cycles conducted in 2017-2018[J]. Hum Reprod, 2025, 40(6): 1110-26. doi：10.1093/humrep/deaf049
[3]	Allersma T, Farquhar C, Cantineau AE. Natural cycle in vitro fertilisation (IVF) for subfertile couples[J]. Cochrane Database Syst Rev, 2013(8): CD010550. doi：10.1002/14651858.cd010550.pub2
[4]	von Wolff M. The role of Natural Cycle IVF in assisted reproduction[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(1): 35-45. doi：10.1016/j.beem.2018.10.005
[5]	Bodri D, Kawachiya S, Kondo M, et al. Oocyte retrieval timing based on spontaneous luteinizing hormone surge during natural cycle in vitro fertilization treatment[J]. Fertil Steril, 2014, 101(4): 1001-7. doi：10.1016/j.fertnstert.2014.01.016
[6]	Tian T, Li Y, Lv J, et al. The potential influence of follicle diameter on natural cycle in vitro fertilization among women with diminished ovarian reserve: a retrospective cohort study[J]. J Ovarian Res, 2023, 16(1): 195. doi：10.1186/s13048-023-01281-4
[7]	Reichman DE, Zakarin L, Chao K, et al. Diminished ovarian reserve is the predominant risk factor for gonadotropin-releasing hormone antagonist failure resulting in breakthrough luteinizing hormone surges in in vitro fertilization cycles[J]. Fertil Steril, 2014, 102(1): 99-102. doi：10.1016/j.fertnstert.2014.04.010
[8]	Lenton EA. Natural cycle IVF with and without terminal HCG: learning from failed cycles[J]. Reprod BioMedicine Online, 2007, 15(2): 149-55. doi：10.1016/S1472-6483(10)60702-X
[9]	Gordon JD, DiMattina M, Reh A, et al. Utilization and success rates of unstimulated in vitro fertilization in the United States: an analysis of the Society for Assisted Reproductive Technology database[J]. Fertil Steril, 2013, 100(2): 392-5. doi：10.1016/j.fertnstert.2013.03.037
[10]	Di Guardo F, Blockeel C, De Vos M, et al. Poor ovarian response and the possible role of natural and modified natural cycles[J]. Ther Adv Reprod Health, 2022, 16: 26334941211062026. doi：10.1177/26334941211062026
[11]	Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting[J]. Hum Reprod, 2011, 26(6): 1270-83. doi：10.1016/j.rbmo.2011.02.001
[12]	Kochhar PK, Ghosh P. Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilization[J]. J Hum Reprod Sci, 2020, 13(3): 191-5. doi：10.4103/jhrs.jhrs_133_19
[13]	Zhu Q, Li Y, Ma J, et al. Potential factors result in diminished ovarian reserve: a comprehensive review[J]. J Ovarian Res, 2023, 16(1): 208. doi：10.1186/s13048-023-01296-x
[14]	Hanson BM, Tao X, Zhan Y, et al. Young women with poor ovarian response exhibit epigenetic age acceleration based on evaluation of white blood cells using a DNA methylation-derived age prediction model[J]. Hum Reprod, 2020, 35(11): 2579-88. doi：10.1093/humrep/deaa206
[15]	Lebovitz O, Haas J, Mor N, et al. Predicting IVF outcome in poor ovarian responders[J]. BMC Womens Health, 2022, 22(1): 395. doi：10.1186/s12905-022-01964-y
[16]	Tiwari M, Chaube SK. Human chorionic gonadotropin mediated generation of reactive oxygen species is sufficient to induce meiotic exit but not apoptosis in rat oocytes[J]. Biores Open Access, 2017, 6(1): 110-22. doi：10.1089/biores.2017.0018
[17]	Wang S, He G, Chen M, et al. The role of antioxidant enzymes in the ovaries[J]. Oxid Med Cell Longev, 2017, 2017: 4371714. doi：10.1155/2017/4371714
[18]	Yano S, Ishiuchi T, Abe S, et al. Histone H3K36me2 and H3K36me3 form a chromatin platform essential for DNMT3A-dependent DNA methylation in mouse oocytes[J]. Nat Commun, 2022, 13(1): 4440. doi：10.1038/s41467-022-32141-2
[19]	Uysal F, Sukur G, Bozdemir N, et al. Unveiling the impact of DNA methylation machinery: Dnmt1 and Dnmt3a in orchestrating oocyte development and cellular homeostasis[J]. Genesis, 2024, 62(1): e23579. doi：10.1002/dvg.23579
[20]	Ai J, Jin L, Zheng Y, et al. The morphology of inner cell mass is the strongest predictor of live birth after a frozen-thawed single embryo transfer[J]. Front Endocrinol: Lausanne, 2021, 12: 621221. doi：10.3389/fendo.2021.621221
[21]	von Wolff M, Kollmann Z, Flück CE, et al. Gonadotrophin stimulation for in vitro fertilization significantly alters the hormone milieu in follicular fluid: a comparative study between natural cycle IVF and conventional IVF[J]. Hum Reprod, 2014, 29(5): 1049-57. doi：10.1093/humrep/deu044
[22]	Polyzos NP, Drakopoulos P, Tournaye H. Modified natural cycle IVF for poor ovarian responders: rethink before concluding[J]. Hum Reprod, 2016, 31(1): 221-2. doi：10.1093/humrep/dev272
[23]	Ho JR, Paulson RJ. Modified natural cycle in in vitro fertilization[J]. Fertil Steril, 2017, 108(4): 572-6. doi：10.1016/j.fertnstert.2017.08.021
[24]	Rackow BW, Kliman HJ, Taylor HS. GnRH antagonists may affect endometrial receptivity[J]. Fertil Steril, 2008, 89(5): 1234-9. doi：10.1016/j.fertnstert.2007.04.060
[25]	Orvieto R, Meltzer S, Rabinson J, et al. GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity[J]. Fertil Steril, 2008, 90(4): 1294-6. doi：10.1016/j.fertnstert.2007.10.022
[26]	Xu B, Geerts D, Hu S, et al. The depot GnRH agonist protocol improves the live birth rate per fresh embryo transfer cycle, but not the cumulative live birth rate in normal responders: a randomized controlled trial and molecular mechanism study[J]. Hum Reprod, 2020, 35(6): 1306-18. doi：10.1093/humrep/deaa086

Variable	Endogenous LH group (n=397)	Exogenous trigger group (n=721)	P
Center			0.1898
Linyi people's hospital	374 (94.21%)	664 (92.09%)
Heze TCM hospital	23 (5.79%)	57 (7.91%)
Age (year)	40.0 (35.0-42.0)	40.0 (35.0-43.0)	0.4998
Age group (years)			0.9400
<35	99 (24.94%)	173 (23.99%)
35-39	95 (23.93%)	175 (24.27%)
≥40	203 (51.13%)	373 (51.73%)
Infertility type: Primary	89 (22.42%)	159 (22.05%)	0.8881
Infertility duration (years)	0.58 (0.25-3.08)	0.83 (0.25-5.50)	0.0129
BMI (kg/m²)	23.43 (21.09-25.64)	23.70 (21.50-25.71)	0.0504
Basal FSH (mIU/mL)	11.26 (7.70-17.14)	9.47 (7.17-14.40)	0.0002
Basal LH (mIU/mL)	4.57 (3.20-6.45)	3.90 (2.64-5.70)	<0.0001
Basal E₂ (pg/mL)	42.11 (25.00-67.25)	46.07 (28.83-69.32)	0.0271
Basal P (ng/mL)	0.40 (0.29-0.65)	0.38 (0.25-0.60)	0.0307
AFC (n)	1.50 (1.00-3.00)	1.50 (1.00-2.50)	0.7408
Trigger day follicle diameter (mm)	16.50 (15.00-18.00)	16.00 (14.50-17.00)	0.0013
Trigger day E₂ (pg/mL)	195.10 (148.15-261.24)	228.56 (187.40-295.66)	<0.0001
Trigger day LH (mIU/mL)	34.43 (22.61-48.27)	8.88 (6.17-12.35)	<0.0001
Trigger day P (ng/mL)	0.83 (0.54-1.11)	0.37 (0.23-0.59)	<0.0001
Endometrial thickness (mm)	9.00 (7.50-10.40)	8.00 (7.00-10.00)	<0.0001

Variable	Endogenous LH group (n=397)	Exogenous trigger group (n=721)	P
Center			0.1898
Linyi people's hospital	374 (94.21%)	664 (92.09%)
Heze TCM hospital	23 (5.79%)	57 (7.91%)
Age (year)	40.0 (35.0-42.0)	40.0 (35.0-43.0)	0.4998
Age group (years)			0.9400
<35	99 (24.94%)	173 (23.99%)
35-39	95 (23.93%)	175 (24.27%)
≥40	203 (51.13%)	373 (51.73%)
Infertility type: Primary	89 (22.42%)	159 (22.05%)	0.8881
Infertility duration (years)	0.58 (0.25-3.08)	0.83 (0.25-5.50)	0.0129
BMI (kg/m²)	23.43 (21.09-25.64)	23.70 (21.50-25.71)	0.0504
Basal FSH (mIU/mL)	11.26 (7.70-17.14)	9.47 (7.17-14.40)	0.0002
Basal LH (mIU/mL)	4.57 (3.20-6.45)	3.90 (2.64-5.70)	<0.0001
Basal E₂ (pg/mL)	42.11 (25.00-67.25)	46.07 (28.83-69.32)	0.0271
Basal P (ng/mL)	0.40 (0.29-0.65)	0.38 (0.25-0.60)	0.0307
AFC (n)	1.50 (1.00-3.00)	1.50 (1.00-2.50)	0.7408
Trigger day follicle diameter (mm)	16.50 (15.00-18.00)	16.00 (14.50-17.00)	0.0013
Trigger day E₂ (pg/mL)	195.10 (148.15-261.24)	228.56 (187.40-295.66)	<0.0001
Trigger day LH (mIU/mL)	34.43 (22.61-48.27)	8.88 (6.17-12.35)	<0.0001
Trigger day P (ng/mL)	0.83 (0.54-1.11)	0.37 (0.23-0.59)	<0.0001
Endometrial thickness (mm)	9.00 (7.50-10.40)	8.00 (7.00-10.00)	<0.0001

Variable	Endogenous LH group (n=397)	Exogenous trigger group (n=397)	P
Center			1.0000
Linyi people's hospital	374 (94.21%)	374 (94.21%)
Heze TCM hospital	23 (5.79%)	23 (5.79%)
Age (year)	40.0 (35.0-42.0)	40.0 (34.0-43.0)	0.5198
Age group (years)			0.6941
<35	99 (24.94%)	101 (25.44%)
35-39	95 (23.93%)	85 (21.41%)
≥40	203 (51.13%)	211 (53.15%)
Infertility type: Primary	89 (22.42%)	89 (22.42%)	1.0000
Infertility duration (years)	0.58 (0.25-3.08)	0.50 (0.25-3.08)	0.3843
BMI (kg/m²)	23.43 (21.09-25.64)	23.40 (21.10-25.70)	0.5879
Basal FSH (mIU/mL)	11.26 (7.70-17.14)	9.45 (7.10-14.57)	0.0018
Basal E₂ (pg/mL)	42.11 (25.00-67.25)	49.01 (30.43-71.20)	0.0172
Basal P (ng/mL)	0.40 (0.29-0.65)	0.40 (0.26-0.63)	0.4502
Basal LH (mIU/mL)	4.57 (3.20-6.45)	4.07 (2.87-5.81)	0.0002
AFC (n)	1.50 (1.00-3.00)	1.50 (1.00-2.50)	0.6952
Trigger day follicle diameter (mm)	16.50 (15.00-18.00)	16.00 (14.50-17.00)	0.0030
Trigger day E₂ (pg/mL)	195.10 (148.15-261.24)	228.78 (190.10-293.50)	<0.0001
Trigger day LH (mIU/mL)	34.43 (22.61-48.27)	9.04 (6.20-12.47)	<0.0001
Trigger day P (ng/mL)	0.83 (0.54-1.11)	0.39 (0.24-0.59)	<0.0001
Endometrial thickness (mm)	9.00 (7.50-10.40)	8.00 (7.00-10.00)	0.0036

Variable	Endogenous LH group (n=397)	Exogenous trigger group (n=397)	P
Center			1.0000
Linyi people's hospital	374 (94.21%)	374 (94.21%)
Heze TCM hospital	23 (5.79%)	23 (5.79%)
Age (year)	40.0 (35.0-42.0)	40.0 (34.0-43.0)	0.5198
Age group (years)			0.6941
<35	99 (24.94%)	101 (25.44%)
35-39	95 (23.93%)	85 (21.41%)
≥40	203 (51.13%)	211 (53.15%)
Infertility type: Primary	89 (22.42%)	89 (22.42%)	1.0000
Infertility duration (years)	0.58 (0.25-3.08)	0.50 (0.25-3.08)	0.3843
BMI (kg/m²)	23.43 (21.09-25.64)	23.40 (21.10-25.70)	0.5879
Basal FSH (mIU/mL)	11.26 (7.70-17.14)	9.45 (7.10-14.57)	0.0018
Basal E₂ (pg/mL)	42.11 (25.00-67.25)	49.01 (30.43-71.20)	0.0172
Basal P (ng/mL)	0.40 (0.29-0.65)	0.40 (0.26-0.63)	0.4502
Basal LH (mIU/mL)	4.57 (3.20-6.45)	4.07 (2.87-5.81)	0.0002
AFC (n)	1.50 (1.00-3.00)	1.50 (1.00-2.50)	0.6952
Trigger day follicle diameter (mm)	16.50 (15.00-18.00)	16.00 (14.50-17.00)	0.0030
Trigger day E₂ (pg/mL)	195.10 (148.15-261.24)	228.78 (190.10-293.50)	<0.0001
Trigger day LH (mIU/mL)	34.43 (22.61-48.27)	9.04 (6.20-12.47)	<0.0001
Trigger day P (ng/mL)	0.83 (0.54-1.11)	0.39 (0.24-0.59)	<0.0001
Endometrial thickness (mm)	9.00 (7.50-10.40)	8.00 (7.00-10.00)	0.0036

Variable	Endogenous LH group (n=397)	Exogenous trigger group (n=397)	P
Oocytes retrieved			0.0189
0	137 (34.51%)	106 (26.70%)
1	258 (64.99%)	291 (73.30%)
2	2 (0.50%)	0
Fertilization method			0.0061
IVF	197 (49.62%)	223 (56.17%)
ICSI	31 (7.81%)	46 (11.59%)
2PN	101 (25.44%)	189 (47.61%)	<0.0001
Available embryos	93 (23.43%)	186 (46.85%)	<0.0001
High-quality embryos	44 (11.08%)	128 (32.24%)	<0.0001
Cycle outcomes			<0.0001
Fresh transfer	45 (11.34%)	92 (23.17%)
Embryo cryopreservation	42 (10.58%)	88 (22.17%)
No available embryos	287 (72.29%)	194 (48.87%)
Clinical pregnancy	9 (2.27%)	33 (8.31%)	0.0001
Live birth	7 (1.76%)	23 (5.79%)	0.0029

外源性药物扳机可改善卵巢功能减退患者自然周期体外受精/卵胞浆内单精子注射助孕的结局：一项倾向性评分匹配及Logistic回归分析

Exogenous triggering with hCG/GnRHa improves outcomes of natural cycle IVF/ICSI in patients with diminished ovarian reserve: a propensity score matching and logistic regression analysis

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 26

相关文章 4

编辑推荐

Metrics

本文评价

Outcome	Factor	Before PSM		After PSM
Outcome	Factor	OR (95%CI)	P	OR (95%CI)	P
Retrieved Oocyte number	Exogenous trigger (yes vs no)	2.04 (1.35-3.08)	0.0008	2.42 (1.53-3.83)	0.0002
	Age (<35 vs 35-39 years)	1.71 (1.13-2.59)	0.0117	-	-
	Age (≥40 vs 35-39 years)	1.28 (0.91-1.79)	0.1568	-	-
	Infertility duration (years)	-	-	1.08 (1.02-1.16)	0.0139
	BMI (kg/m²)	0.96 (0.92-1.00)	0.0376	0.93 (0.88-0.99)	0.0176
	Basal FSH (mIU/mL)	0.97 (0.95-0.98)	<0.0001	0.97 (0.95-0.98)	0.0002
	Decision-day LH (mIU/mL)	1.01 (1.00-1.02)	0.0154	1.02 (1.01-1.03)	0.0032
2PN	Exogenous trigger (Yes vs No)	2.32 (1.73-3.11)	<0.0001	2.65 (1.91-3.67)	<0.0001
	Infertility type (secondary vs primary)	1.86 (1.33-2.59)	0.0003	2.08 (1.38-3.14)	0.0004
	BMI (kg/m²)	0.95 (0.91-0.99)	0.0240	-	-
	Basal FSH (mIU/mL)	0.98 (0.96-0.99)	0.0099	-	-
Available embryos	Exogenous trigger (Yes vs No)	2.31 (1.72-3.10)	<0.0001	2.72 (1.97-3.78)	<0.0001
	Infertility type (secondary vs primary)	1.56 (1.12-2.16)	0.0077	2.01 (1.34-3.03)	0.0008
	Basal FSH (mIU/mL)	0.98 (0.96-1.00)	0.0118	-	-
High-quality embryos	Exogenous trigger (Yes vs No)	3.38 (2.32-4.93)	<0.0001	3.78 (2.53-5.67)	<0.0001
	Age (<35 vs 35-39 years)	0.81 (0.52-1.26)	0.3412	-	-
	Age (≥40 vs 35-39 years)	0.62 (0.43-0.90)	0.0108	-	-
	Infertility type (secondary vs primary)	1.73 (1.14-2.64)	0.0108	2.08 (1.26-3.45)	0.0044
Clinical pregnancy	Exogenous trigger (Yes vs No)	2.95 (1.40-6.24)	0.0045	4.13 (1.86-9.18)	0.0005
	Age (<35 vs 35-39 years)	0.79 (0.40-1.54)	0.4882	1.14 (0.49-2.62)	0.7618
	Age (≥40 vs 35-39 years)	0.25 (0.12-0.50)	0.0001	0.16 (0.07-0.39)	<0.0001
	Infertility type (secondary vs primary)	-	-	3.97 (1.39-11.31)	0.0098
	Basal E₂ (pg/mL)	1.00 (1.00-1.01)	0.0006	1.00 (1.00-1.01)	0.0016
Live birth	Exogenous trigger (Yes vs No)	2.94 (1.24-7.00)	0.0146	4.11 (1.64-10.32)	0.0026
	Age (<35 vs 35-39 years)	1.13 (0.52-2.45)	0.7535	1.31 (0.53-3.22)	0.5636
	Age (≥40 vs 35-39 years)	0.13 (0.05-0.34)	<0.0001	0.08 (0.02-0.27)	<0.0001
	Infertility type (secondary vs primary)	3.09 (1.20-7.92)	0.0191	5.90 (1.62-21.53)	0.0072
	Basal E2 (pg/mL)	1.00 (1.00-1.01)	0.0005	1.00 (1.00-1.01)	0.0008

Subgroup	Clinical outcome	P	OR (95% CI)
Logistic regression
Age<35 years	Available embryos	0.0264	1.95 (1.08-3.53)
	High-quality embryos	0.0009	3.99 (1.76-9.04)
Age 35-39 years	Available embryos	0.0014	2.70 (1.47-4.98)
	High-quality embryos	0.0045	2.68 (1.36-5.30)
Age≥40 years	2PN	<0.0001	2.55 (1.70-3.81)
	Available embryos	<0.0001	2.45 (1.63-3.68)
	High-quality embryos	<0.0001	3.37 (1.96-5.79)
PSM analysis
Age <35 years	Available embryos	0.0171	2.29 (1.16-4.51)
	High-quality embryos	0.0011	4.38 (1.81-10.60)
Age 35-39 years	Retrieved oocyte number	0.0274	2.17 (1.09-4.32)
	Available embryos	0.0013	3.24 (1.58-6.64)
	High-quality embryos	0.0046	2.97 (1.40-6.32)
	Clinical pregnancy	0.0151	5.01 (1.37-18.37)
	Live birth	0.0199	6.25 (1.34-29.23)
Age≥40 years	2PN	<0.0001	3.18 (2.02-5.00)
	Available embryos	<0.0001	2.84 (1.82-4.43)
	High-quality embryos	<0.0001	4.25 (2.38-7.60)

[1]	张庆颜, 张俊, 周星宇, 黎莹, 陈映雪, 陈薪, 陈士岭. 高龄不孕症患者冻融胚胎移植胚胎数目和质量与早期妊娠丢失率的关系[J]. 南方医科大学学报, 2021, 41(7): 1050-1055.
[2]	吴晓敏, 陈映雪, 周星宇, 张俊, 黎莹, 李欣, 张笑菲, 陈士岭. 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[J]. 南方医科大学学报, 2021, 41(3): 412-417.
[3]	谢多，邱卓琳，罗琛，褚庆军，全松. ICSI 中不同来源精子对卵母细胞受精、胚胎质量及发育潜能的影响[J]. 南方医科大学学报, 2014, 34(06): 857-.
[4]	陈士岭，罗燕群，夏容，陈薪，施晓鋆，郑海燕，王乐乐，吴雅琴. 年轻妇女基础FSH 高水平与卵子和胚胎的数量、质量及临床结局的关系[J]. 南方医科大学学报, 2011, 31(05): 777-.