半剂量和全剂量 GnRH 拮抗剂对 IVF-ET 结局的影响：一项回顾性研究。
Effects of half-dose and full-dose GnRH antagonists on IVF-ET outcomes: a retrospective study.
机构信息
Shandong University of Traditional Chinese Medicine, Jinan, China.
Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
出版信息
BMC Pregnancy Childbirth. 2021 Oct 27;21(1):727. doi: 10.1186/s12884-021-04176-8.
BACKGROUND
Gonadotropin-releasing hormone antagonist(GnRH-ant) has been shown to have a negative effect on endometrial receptivity. Therefore, the use of lower doses of GnRH-ant during controlled ovarian stimulation (COS) may improve endometrial receptivity and clinical pregnancy rate. However, the GnRH-ant dose is relatively flexible and there is no fixed requirement for guidance. In this retrospective study, we determined the effects of half-dose and full-dose GnRH-ant on IVF-ET outcomes.
METHODS
Of the 316 cycles in the 314 patients analyzed in this study, 149 received GnRH-ant half-dose (Group1), while 167 received GnRH-ant full-dose (Group2). The groups were further classified based on age and BMI. Age subgroups, were divided as age ≤ 35(subgroup A) and age > 35(subgroup B): 180 cycles in subgroup A (107 cycles in subgroup A1,73 cycles in subgroup A2), 136 cycles in subgroup B (42 cycles in subgroup B1,94 cycles in subgroupB2). The subgroups based on BMI were divided as BMI < 25 (subgroup C)and BMI ≥ 25 (subgroup D):208 cycles in subgroup C (94 cycles in subgroup C1,114 cycles in subgroup C2), 108 cycles in subgroup D (55 cycles in subgroup D1,53 cycles in subgroup D2).
RESULTS
The number of fertilized oocytes, superior-quality embryos, clinical pregnancy rate, and live birth rate differed significantly between the two groups. However, the number of retrieved oocytes and available embryos were significantly higher in Group 1 than Group 2 (8.17 ± 4.10 vs. 7.07 ± 4.05, 2.96 ± 2.03 vs. 2.52 ± 1.62, respectively,p<0.05). Differences between the age subgroups were not statistically significant. However, in the subgroups based on BMI, the fertilized oocytes, available embryos, the number of superior-quality embryos, and the live birth rate differed significantly between the four subgroups. The number of retrieved oocytes was higher in subgroup C1 than in subgroup C2 (8.24 ± 4.04 vs. 6.83 ± 3.92,p < 0.05), In addition, the clinical pregnancy rate was slightly higher in subgroup D1 than in subgroup D2(45.45 vs. 24.53%, P < 0.05).
CONCLUSIONS
The results showed that half-dose GnRH-ant was as effective as full-dose GnRH-ant for most patients. Moreover, half-dose GnRH-ant may be more suitable in patients with BMI greater than or equal to 25. The findings of this study need to be validated in a large sample RCT.
TRIAL REGISTRATION
Retrospectively registered.
背景
促性腺激素释放激素拮抗剂（GnRH-ant）已被证明对子宫内膜容受性有负面影响。因此，在控制性卵巢刺激（COS）期间使用较低剂量的 GnRH-ant 可能会提高子宫内膜容受性和临床妊娠率。然而，GnRH-ant 的剂量相对灵活，没有固定的指导要求。在这项回顾性研究中，我们确定了 GnRH-ant 半剂量和全剂量对 IVF-ET 结局的影响。
方法
在本研究中分析的 314 名患者的 316 个周期中，149 个接受 GnRH-ant 半剂量（组 1），167 个接受 GnRH-ant 全剂量（组 2）。这些组进一步根据年龄和 BMI 进行分类。年龄亚组分为年龄≤35 岁（亚组 A）和年龄>35 岁（亚组 B）：亚组 A 中有 180 个周期（亚组 A1 中有 107 个周期，亚组 A2 中有 73 个周期），亚组 B 中有 136 个周期（亚组 B1 中有 42 个周期，亚组 B2 中有 94 个周期）。BMI 亚组分为 BMI<25（亚组 C）和 BMI≥25（亚组 D）：亚组 C 中有 208 个周期（亚组 C1 中有 94 个周期，亚组 C2 中有 114 个周期），亚组 D 中有 108 个周期（亚组 D1 中有 55 个周期，亚组 D2 中有 53 个周期）。
结果
两组的受精卵数、优质胚胎数、临床妊娠率和活产率差异有统计学意义。然而，组 1 的取卵数和可用胚胎数明显高于组 2（8.17±4.10 与 7.07±4.05，2.96±2.03 与 2.52±1.62，均 p<0.05）。年龄亚组之间的差异无统计学意义。然而，在基于 BMI 的亚组中，四个亚组之间的受精卵数、可用胚胎数、优质胚胎数和活产率差异有统计学意义。亚组 C1 的取卵数高于亚组 C2（8.24±4.04 与 6.83±3.92，p<0.05）。此外，亚组 D1 的临床妊娠率略高于亚组 D2（45.45% 与 24.53%，p<0.05）。
结论
结果表明，GnRH-ant 半剂量对大多数患者与全剂量一样有效。此外，GnRH-ant 半剂量可能更适合 BMI 大于或等于 25 的患者。本研究的结果需要在大规模 RCT 中进行验证。
试验注册
回顾性注册。
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