正常反应人群拮抗剂方案与激动剂长方案的临床特点及结局比较

张争; 蒋承芳; 李玉艳; 何畏

doi:10.16016/j.2097-0927.202107177

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正常反应人群拮抗剂方案与激动剂长方案的临床特点及结局比较

临床医学 | 更新时间：2026-01-09

- 正常反应人群拮抗剂方案与激动剂长方案的临床特点及结局比较
- Clinical features and outcomes of IVF-ET cycles between GnRH antagonist and GnRH agonist long protocol in normal responders: a comparison of 266 cases
- 陆军军医大学学报 2022年44卷第5期页码：484-488
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院妇产科，生殖医学中心
- 作者简介：
  
  [ 何畏，E-mail：anyhewei@163.com HE Wei, E-mail: anyhewei@163.com
- 基金信息：
  
  计生专项科研课题(17JS002)
- DOI：10.16016/j.2097-0927.202107177
  中图分类号： R181.35;R711.6;R977.12
- 收稿：2021-07-28，
  
  修回：2021-11-12，
  
  纸质出版：2022-03-15
- 稿件说明：
移动端阅览
张争, 蒋承芳, 李玉艳, 等. 正常反应人群拮抗剂方案与激动剂长方案的临床特点及结局比较[J]. 陆军军医大学学报, 2022,44(5):484-488.

Zheng ZHANG, Chengfang JIANG, Yuyan LI, et al. Clinical features and outcomes of IVF-ET cycles between GnRH antagonist and GnRH agonist long protocol in normal responders: a comparison of 266 cases[J]. Journal of Army Medical University, 2022, 44(5): 484-488.
张争, 蒋承芳, 李玉艳, 等. 正常反应人群拮抗剂方案与激动剂长方案的临床特点及结局比较[J]. 陆军军医大学学报, 2022,44(5):484-488. DOI： 10.16016/j.2097-0927.202107177.

Zheng ZHANG, Chengfang JIANG, Yuyan LI, et al. Clinical features and outcomes of IVF-ET cycles between GnRH antagonist and GnRH agonist long protocol in normal responders: a comparison of 266 cases[J]. Journal of Army Medical University, 2022, 44(5): 484-488. DOI： 10.16016/j.2097-0927.202107177.

摘要

目的

分析比较体外授精-胚胎移植(

in vitro

fertilization-embryo transfer

IVF-ET)治疗中采用促性腺激素释放激素(gonadotrophin releasing hormone

GnRH)拮抗剂方案(简称拮抗剂方案)或激动剂长方案(简称长方案)的正常反应人群IVF-ET周期的临床特点及结局。

方法

收集2017年1月至2019年3月我中心接受IVF-ET治疗采用拮抗剂或长方案的卵巢正常反应患者的临床资料，根据新鲜周期的方案及是否移植分为3组，A组：拮抗剂未移植组(128例)，B组：拮抗剂移植组(138例)，C组：长方案移植组(720例)；同时，进一步统计拮抗剂未移植组患者第1次冷冻胚胎移植(frozen embryo transfer，FET)转化日内膜厚度及临床结局，作为D组，比较拮抗剂方案与长方案在正常反应人群中应用的临床特点及结局。

结果

① A、B组使用促性腺激素(gonadotropin

Gn)时间及用量均＜C组，其中Gn时间差异均有统计学意义(

0.05)，Gn用量A组及C组间差异有统计学意义(

0.05)；②A、B组绒毛膜促性腺激素(chorionic gonadotropin，HCG)日血清雌二醇(estradiol

E2)水平均低于C组(

0.05)；HCG日内膜C组最厚，D组黄体转化日内膜均低于A、B、C 3组，其中A组与B组、C组及D组间的差异均有统计学意义(

0.05)；③A、B组获卵数均＜C组(

0.05)，A、B组及C组间成熟卵(metaphase Ⅱ

MⅡ)卵率、正常受精率及优质胚胎率差异均无统计学意义(

0.05)；④B、C、D 3组患者生化妊娠率、临床妊娠率差异均无统计学意义，B组患者着床率最低，流产率最高，与C组间差异有统计学意义(

0.05)。

结论

正常反应人群拮抗剂方案可获得与长方案相似的卵母细胞及胚胎，拮抗剂对子宫内膜容受性的负面影响可能会引起临床妊娠率低，流产率高。

Abstract

Objective

To analyze and compare the clinical features and outcomes of

in vitro

fertilization-embryo transfer (IVF-ET) cycles in normal responders

using gonadotrophin (Gn) releasing hormone (GnRH) antagonist or GnRH agonist long protocol.

Methods

The clinical data of patients who received IVF treatment and had normal ovarian response to GnRH antagonist or GnRH agonist long protocol in our reproductive center from January 2017 to March 2019 were collected. According to the treatment protocol and the fresh embryo transplanted or not

these patients were divided into Group A (receiving GnRH antagonist

but no fresh embryo transplanted

=128)

Group B (GnRH antagonist

with fresh embryo transplanted

=138)

and Group C (GnRH agonist long protocol

with fresh embryo transplanted

=720). Besides

the frozen embryo transfer (FET) cycles of Group A were analyzed

and served as Group D. The thickness of endometrium on luteal conversion day and outcome of Group D were compared with those of Group B and Group C.

Results

① The duration and dosage of Gn were shorter and less in Group A and B than Group C

and statistical difference was seen in Gn duration (

0.05)

and in Gn dosage only between Group A and C (

0.05). ②On HCG day

the serum estradiol (E2) level were lower in Group A and B than Group C (

0.05)

the endometrium of Group C was the thickest

and the thickness of endometrium on luteal conversion day of Group D was lower than that on the HCG day of Group A

B and C

where the differences between Group A and B

and Group C and D were statistically significant (

0.05). ③ The number of oocytes obtained in Group A and B were less than that in Group C (

0.05)

but there were no statistical difference in metaphase Ⅱ (MⅡ) oocyte rate

normal fertilization rate and high-quality embryo rate among Group A

B and C. ④ Biochemical pregnancy rate and clinical pregnancy rate had no statistical differences among Group B

and D (

0.05). Group B had the lowest implantation rate but the highest miscarriage rate

and had obvious differences with Group C (

0.05).

Conclusion

GnRH antagonist protocol can obtain similar oocytes and embryos as the GnRH-a long protocol in normal response population. However

the antagonist may exert negative impact on endometrial receptivity and result in low pregnancy rate and high abortion rate.

关键词

Keywords

references

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