Li F, Ye T, Kong H J, Li J, Hu L L, Yang H Y, Guo Y H, Li G
Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Fu Chan Ke Za Zhi. 2021 Jul 25;56(7):482-488. doi: 10.3760/cma.j.cn112141-20210219-00084.
To investigate the influence of age on the fresh cycle live birth rate in patients with poor ovarian response in different controlled ovarian hyperstimulation groups. The clinical data of 3 342 patients in The First Affiliated Hospital of Zhengzhou University from February 2014 to November 2018 were retrospectively collected, including early-follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long protocol group (1 375 cases), mid-luteal phase short-acting GnRH agonist long protocol group (1 161 cases) and GnRH antagonist protocol group (806 cases); each group was divided into 4 subgroups according to age: ≤30 years, 31－35 years, 36－40 years and >40 years, the pregnancy outcomes in each age subgroup were analyzed under different controlled ovarian hyperstimulation protocols. In early-follicular phase long-acting GnRH agonist long protocol group, the final live birth rates of each age subgroup were 39.4% (228/579), 36.1% (135/374), 16.6% (48/290) and 3.0% (4/132); in mid-luteal phase short-acting GnRH agonist long protocol group, live birth rates of each age subgroup were 32.1% (99/308), 20.8% (55/264), 13.0% (45/346) and 7.0% (17/243); in GnRH antagonist protocol group, live birth rates of each age subgroup were 22.8% (26/114), 16.3% (25/153), 11.2% (31/278), and 3.8% (10/261); the live birth rate of each group decreased significantly with the increase of age (all <0.01). When the age≤35 years old, the fresh cycle live birth rate of the early-follicular phase long-acting GnRH agonist long protocol group was significantly better than those of the other two groups (all <0.01). The multivariate logistic regression analysis of age and live birth rate of the three controlled ovarian hyperstimulation groups showed age was the independent influence factor (=0.898, 95%: 0.873-0.916, <0.01; =0.926, 95%: 0.890-0.996, <0.01; =0.901, 95%: 0.863-0.960, <0.01). Age is an independent influencing factor for the prediction of fresh cycle live birth rate in low ovarian response patients. No matter which controlled ovarian hyperstimulation protocol is adopted, the final live birth rate decreases significantly with the increase of women's age. In addition, the early-follicular phase long-acting GnRH agonist long protocol has the highest fresh cycle live birth rate among all controlled ovarian hyperstimulation groups.
探讨不同控制性卵巢刺激方案中年龄对卵巢反应不良患者新鲜周期活产率的影响。回顾性收集2014年2月至2018年11月郑州大学第一附属医院3342例患者的临床资料，包括卵泡期长效促性腺激素释放激素（GnRH）激动剂长方案组（1375例）、黄体中期短效GnRH激动剂长方案组（1161例）和GnRH拮抗剂方案组（806例）；每组根据年龄分为4个亚组：≤30岁、31 - 35岁、36 - 40岁和>40岁，分析不同控制性卵巢刺激方案下各年龄亚组的妊娠结局。在卵泡期长效GnRH激动剂长方案组中，各年龄亚组的最终活产率分别为39.4%（228/579）、36.1%（135/374）、16.6%（48/290）和3.0%（4/132）；在黄体中期短效GnRH激动剂长方案组中，各年龄亚组的活产率分别为32.1%（99/308）、20.8%（55/264）、13.0%（45/346）和7.0%（17/243）；在GnRH拮抗剂方案组中，各年龄亚组的活产率分别为22.8%（26/114）、16.3%（25/153）、11.2%（31/278）和3.8%（10/261）；各组的活产率均随年龄增加而显著降低（均<0.01）。当年龄≤35岁时，卵泡期长效GnRH激动剂长方案组的新鲜周期活产率显著优于其他两组（均<0.01）。对三个控制性卵巢刺激组的年龄和活产率进行多因素逻辑回归分析显示年龄是独立影响因素（=0.898，95%：0.873 - 0.916，<0.01；=0.926，95%：0.890 - 0.996，<0.01；=0.901，95%：0.863 - 0.960，<0.01）。年龄是预测卵巢反应低下患者新鲜周期活产率的独立影响因素。无论采用哪种控制性卵巢刺激方案，最终活产率均随女性年龄增加而显著降低。此外，卵泡期长效GnRH激动剂长方案在所有控制性卵巢刺激组中新鲜周期活产率最高。
