促性腺激素释放激素拮抗剂方案与促性腺激素释放激素激动剂长方案：临床结局和母婴安全性的回顾性队列研究。
GnRH Antagonist Protocol Versus GnRH Agonist Long Protocol: A Retrospective Cohort Study on Clinical Outcomes and Maternal-Neonatal Safety.
机构信息
Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jun 29;13:875779. doi: 10.3389/fendo.2022.875779. eCollection 2022.
OBJECTIVE
To evaluate the clinical outcomes and maternal-neonatal safety of gonadotropin releasing hormone antagonist (GnRH-ant) and gonadotropin releasing hormone agonist (GnRH-a) protocols.
METHODS
A total of 2505 women undergoing their first fertilization (IVF)/intracytoplasmic sperm injection (ICSI) were retrospectively analyzed. Patients were divided into GnRH-ant group (n = 1514) and GnRH-a group (n = 991) according their stimulation protocol. Propensity Score Matching (PSM) was used for balancing the baseline of two groups. The pregnancy outcomes were analyzed in fresh transfer cycles, and the obstetric and perinatal outcomes were calculated in singleton live births of fresh cycles. The primary outcome was the live birth rate. The secondary outcome measures were maternal complications, preterm birth rate, low birthweight rate, multiple pregnancy rate, and moderate-severe OHSS rate.
RESULTS
After 1:1 PSM, baseline characteristics of the GnRH-ant group and GnRH-a group were matched and assigned 991 cycles in each group. Before PSM, there were 700 fresh cycles including 237 singleton live births in the GnRH-ant group and 588 fresh cycles including 187 singleton live births in the GnRH-a group. After PSM, there were 471 fresh cycles including 166 singleton live births in the GnRH-ant group and 588 fresh cycles including 187 singleton live births in the GnRH-a group. No significant differences were observed in the live birth rate (44.6% vs 48.8%), maternal complications, preterm birth rate (9.0% vs 6.4%), and low birthweight rate (17.5% vs 24.1%) between two groups after PSM ( > 0.05). The moderate-severe OHSS rate (2.9% vs 6.0%, = 0.002) and multiple pregnancy rate (24.5% vs 33.1%, = 0.025) was significantly lower in the GnRH-ant group than that in the GnRH-a group after PSM.
CONCLUSION
GnRH-ant protocol was comparable with GnRH-a protocol in clinical outcomes, obstetric and perinatal outcomes, and with a lower risk of OHSS. For those who want to get an effective and safe outcome, and a shorter treatment period, GnRH-ant is a suitable choice.
目的
评估促性腺激素释放激素拮抗剂（GnRH-ant）和促性腺激素释放激素激动剂（GnRH-a）方案的临床结局和母婴安全性。
方法
回顾性分析了 2505 名首次接受体外受精（IVF）/胞浆内单精子注射（ICSI）的女性患者。根据其刺激方案，患者分为 GnRH-ant 组（n=1514）和 GnRH-a 组（n=991）。采用倾向评分匹配（PSM）平衡两组的基线。对新鲜移植周期进行妊娠结局分析，对新鲜周期的单胎活产进行产科和围产儿结局计算。主要结局为活产率。次要结局指标为产妇并发症、早产率、低出生体重率、多胎妊娠率和中重度卵巢过度刺激综合征（OHSS）发生率。
结果
经 1:1 PSM 后，GnRH-ant 组和 GnRH-a 组的基线特征匹配，每组分配 991 个周期。PSM 前，GnRH-ant 组有 700 个新鲜周期，包括 237 例单胎活产，GnRH-a 组有 588 个新鲜周期，包括 187 例单胎活产。PSM 后，GnRH-ant 组有 471 个新鲜周期，包括 166 例单胎活产，GnRH-a 组有 588 个新鲜周期，包括 187 例单胎活产。PSM 后，两组活产率（44.6% vs. 48.8%）、产妇并发症、早产率（9.0% vs. 6.4%）和低出生体重率（17.5% vs. 24.1%）无显著差异（>0.05）。PSM 后，GnRH-ant 组中重度 OHSS 发生率（2.9% vs. 6.0%， = 0.002）和多胎妊娠率（24.5% vs. 33.1%， = 0.025）明显低于 GnRH-a 组。
结论
与 GnRH-a 方案相比，GnRH-ant 方案在临床结局、产科和围产儿结局方面相似，且 OHSS 风险较低。对于那些希望获得有效、安全的治疗效果，且治疗周期较短的患者，GnRH-ant 是一种合适的选择。
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