在体外受精/卵胞浆内单精子注射拮抗剂方案中，西曲瑞克和加尼瑞克对妊娠结局及安全性的比较：一项回顾性队列研究
Comparison of pregnancy outcomes and safety between cetrorelix and ganirelix in IVF/ICSI antagonist protocols: a retrospective cohort study.
作者信息
Peng Xinyue, Lv Xingyu, Li Penghao, Li Yingxing, Hu Yuling, Zhang Yi, Li Yuan
机构信息
Department of Reproductive Medicine, Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, Sichuan, China.
Department of Scientific Research and Education, Chengdu Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu, Sichuan, China.
出版信息
Front Reprod Health. 2025 Apr 14;7:1492441. doi: 10.3389/frph.2025.1492441. eCollection 2025.
INTRODUCTION
This study aimed to compare the safety, efficacy, and clinical predictors of live birth outcomes between cetrorelix and ganirelix in GnRH antagonist protocols during controlled ovarian stimulation.
METHODS
In this retrospective cohort study conducted at a reproductive medicine center (June 2019-June 2022), 2,365 patients receiving cetrorelix (Group A) and 7,059 patients receiving ganirelix (Group B) were analyzed after 1:3 propensity score matching. Outcomes included LH surge suppression, OHSS incidence, endometrial morphology, embryological parameters, and live birth rates. Multivariate logistic regression identified independent predictors of clinical success.
RESULTS
Cetrorelix demonstrated superior LH surge control, with lower incidences of LH ≥10 U/L (4.9% vs. 7.6%, < 0.001) and LH ratio(trigger day LH Gn day LH) ≥2 (6.1% vs. 9.2%, < 0.001). Endometrial receptivity was more favorable in Group A, with higher Type A (66.2% vs. 60.1%) and lower Type C morphology (5.3% vs. 6.3%, < 0.001). Ganirelix showed a higher overall OHSS incidence (1.1% vs. 0.4%, = 0.01). Live birth rates were comparable (47.2% vs. 49.4%, = 0.074). Multivariate analysis revealed advanced female age (≥35 years) reduced success (aOR = 0.65, 95% CI 0.57-0.74, < 0.001), while AMH ≥4 μg/L (aOR = 1.29, 95% CI 1.02-1.64, = 0.034), and dual embryo transfer (aOR = 1.51, 95% CI 1.38-1.65, < 0.001) improved outcomes.
CONCLUSION
Cetrorelix and ganirelix demonstrate comparable live birth rates and embryo quality, yet exhibit distinct safety profiles. Cetrorelix provides superior LH surge suppression and reduced OHSS risk, making it preferable for high-risk patients, while ganirelix may serve cases requiring rapid LH control. Cetrorelix offering enhanced endometrial receptivity (66.2% Type A morphology) and safety advantages. These findings support cetrorelix's role in optimizing ART safety without compromising efficacy.
引言
本研究旨在比较在控制性卵巢刺激过程中，使用西曲瑞克和加尼瑞克的促性腺激素释放激素（GnRH）拮抗剂方案的活产结局的安全性、有效性和临床预测因素。
方法
在一家生殖医学中心进行的这项回顾性队列研究（2019年6月至2022年6月）中，对2365例接受西曲瑞克治疗的患者（A组）和7059例接受加尼瑞克治疗的患者（B组）进行了1:3倾向评分匹配后分析。结局指标包括促黄体生成素（LH）峰抑制、卵巢过度刺激综合征（OHSS）发生率、子宫内膜形态、胚胎学参数和活产率。多因素逻辑回归确定了临床成功的独立预测因素。
结果
西曲瑞克在LH峰控制方面表现更优，LH≥10 U/L的发生率较低（4.9%对7.6%，P<0.001），LH比值（扳机日LH/促性腺激素释放激素激动剂日LH）≥2的发生率也较低（6.1%对9.2%，P<0.001）。A组的子宫内膜容受性更佳，A型比例更高（66.2%对60.1%），C型形态比例更低（5.3%对6.3%，P<0.001）。加尼瑞克的总体OHSS发生率更高（1.1%对0.4%，P=0.01）。活产率相当（47.2%对49.4%，P=0.074）。多因素分析显示，女性年龄≥35岁会降低成功率（调整后比值比[aOR]=0.65，95%置信区间[CI] 0.57 - 0.74，P<0.001），而抗缪勒管激素（AMH）≥4 μg/L（aOR=1.29，95% CI 1.02 - 1.64，P=0.034）和双胚胎移植（aOR=1.51，95% CI 1.38 - 1.65，P<0.001）会改善结局。
结论
西曲瑞克和加尼瑞克的活产率和胚胎质量相当，但安全性特征不同。西曲瑞克能更好地抑制LH峰并降低OHSS风险，更适合高危患者，而加尼瑞克可能适用于需要快速控制LH的情况。西曲瑞克具有增强的子宫内膜容受性（A型形态占66.2%）和安全性优势。这些发现支持西曲瑞克在优化辅助生殖技术（ART）安全性且不影响疗效方面的作用。
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