Yu Ya, Wei Kai, Yao Qiuping, Tian Shen, Liang Kun, Zhou Liming, Wang Liping, Jin Min
Reproductive Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
Reproductive Center, Jiaxing Women and Children's Hospital, Jiaxing 314051, Zhejiang Province, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 Apr 25;48(2):165-173. doi: 10.3785/j.issn.1008-9292.2019.04.07.
To compare laboratory and clinical outcomes of fertilization-embryo transfer (IVF-ET) in patients with endometriosis using antagonist protocol, long agonist protocol or prolonged agonist protocol.
Totally 313 patients with endometriosis were recruited in Reproductive Centers of the Second Affiliated Hospital of Zhejiang University School of Medicine,Jiaxing Women and Children's Hospital,and Ningbo Women and Children's Hospital from April 2017 to October 2018, including 81 patients treated with antagonist protocol (antagonist group), 148 treated with long agonist protocol (long agonist group) and 84 treated with prolonged agonist protocol (prolonged agonist group). The clinical and laboratory data of the patients were retrospectively analyzed to investigate the effect of ovarian stimulation protocols on the IVF-ET outcomes of patients with endometriosis.
The average age in the antagonist group patients was significantly higher than those in the other two groups (all <0.05),and anti-mullerian hormone (AMH) level and antral follicle numbers were significantly lower than those in the other two groups (all <0.01). The numbers of average retrieved oocyte, fertilized oocyte and available embryo in the antagonist group were significantly lower than those in the long agonist group (all <0.05), but were similar with those in the prolonged agonist group (all >0.05). Fertilization rate and available embryo rate were comparable among the three groups (all >0.05). Considering analysis per cycle with embryo transfer, the human chorionic gonadotrophin (HCG) positive rate, clinical pregnancy rate and total implantation rate showed no significant difference among the three groups (all >0.05). The implantation rate after fresh embryo transfer in the antagonist group was lower than that in the long agonist group (<0.05), but was similar with that in the prolonged agonist group (>0.05). While the implantation rate of freeze-thaw embryo transfer showed a higher trend in the antagonist group, but there was no significant difference (>0.05). The patients were further divided into diminished and normal ovarian reserve subgroups, the per cycle with embryo transfer, the HCG positive rate, clinical pregnancy rate and total implantation rate still showed no significant difference between two subgroups (all >0.05), no matter in which ovarian stimulation protocol groups. Besides, in women with diminished ovarian reserve, the available embryo rate in antagonist group was significantly higher than that in the long agonist group (<0.05). The amount and duration of Gn application in antagonist group were significantly lower than those in long and prolonged agonist groups (all <0.05).
Patients with endometriosis who used the antagonist protocol in IVF procedure could reduce the cost and time of Gn treatment, when combined with frozen-embryo transfer strategy the antagonist protocol has comparable clinical pregnancy outcome with long or prolonged agonist protocol, especially in those with diminished ovarian reserve, the higher available embryo rate can be achieved.
比较采用拮抗剂方案、长效激动剂方案或延长激动剂方案进行体外受精-胚胎移植（IVF-ET）的子宫内膜异位症患者的实验室及临床结局。
2017年4月至2018年10月，浙江大学医学院附属第二医院、嘉兴市妇幼保健院及宁波市妇女儿童医院生殖中心共招募313例子宫内膜异位症患者，其中81例采用拮抗剂方案治疗（拮抗剂组），148例采用长效激动剂方案治疗（长效激动剂组），84例采用延长激动剂方案治疗（延长激动剂组）。回顾性分析患者的临床及实验室数据，以探讨卵巢刺激方案对子宫内膜异位症患者IVF-ET结局的影响。
拮抗剂组患者的平均年龄显著高于其他两组（均<0.05），抗苗勒管激素（AMH）水平及窦卵泡数显著低于其他两组（均<0.01）。拮抗剂组平均获卵数、受精卵数及可用胚胎数均显著低于长效激动剂组（均<0.05），但与延长激动剂组相似（均>0.05）。三组的受精率及可用胚胎率相当（均>0.05）。考虑胚胎移植周期分析，三组的人绒毛膜促性腺激素（HCG）阳性率、临床妊娠率及总种植率均无显著差异（均>0.05）。拮抗剂组新鲜胚胎移植后的种植率低于长效激动剂组（<0.05），但与延长激动剂组相似（>0.05）。虽然拮抗剂组冻融胚胎移植的种植率有升高趋势，但无显著差异（>0.05）。患者进一步分为卵巢储备功能减退和正常亚组，无论采用何种卵巢刺激方案组，胚胎移植周期中，两个亚组的HCG阳性率、临床妊娠率及总种植率仍无显著差异（均>0.05）。此外，在卵巢储备功能减退的女性中，拮抗剂组的可用胚胎率显著高于长效激动剂组（<0.05）。拮抗剂组促性腺激素（Gn）的用量及使用时间均显著低于长效和延长激动剂组（均<0.05）。
IVF过程中采用拮抗剂方案的子宫内膜异位症患者可降低Gn治疗的费用和时间，联合冻融胚胎移植策略时，拮抗剂方案与长效或延长激动剂方案的临床妊娠结局相当，尤其是在卵巢储备功能减退的患者中，可获得更高的可用胚胎率。
