高龄产妇体外受精中hCG与双重触发方案的比较分析：一项基于倾向评分匹配的单中心回顾性队列研究
Comparative analysis of hCG and dual-trigger protocols in IVF for advanced maternal age women: a single‑center retrospective cohort study based on propensity score matching.
作者信息
Yuan Minghui, Lv Xuemei, Yuan Yuying, Ju Wenhan, Song Jingyan, Pang Conghui, Zhao Shuai, Chen Wen, Lian Fang, Wu Zhijuan
机构信息
Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
出版信息
Arch Gynecol Obstet. 2025 May 2. doi: 10.1007/s00404-025-08037-z.
PURPOSE
This study aimed to compare the efficacy of human chorionic gonadotropin (hCG) and dual-trigger (gonadotropin-releasing hormone agonist [GnRH-a] and hCG) protocols in terms of cumulative live birth rate (CLBR) and other pregnancy outcomes among advanced-age women.
METHODS
We enrolled 801 women aged ≥ 35 years who were experiencing infertility and beginning their first in vitro fertilization cycle at a tertiary academic medical institution between August 2015 and June 2023. Among these, 115 and 686 women used the dual-trigger and hCG methods. Propensity score matching was employed to account for confounding variables. The main outcomes evaluated were CLBR and time to live birth (TTLB).
RESULTS
The CLBR did not differ significantly between the hCG and dual-trigger groups (29.86% vs. 26.09%, P = 0.44), whereas the TTLBs of both groups were similar (9.60 vs. 10.14 months, P = 0.72). CLBR results were similar for both groups, according to a Kaplan-Meier analysis (hazard ratio [HR] = 0.95; 95% confidence interval [CI] 0.63-1.43; P = 0.82). After a multiple Cox proportional hazards model was established, the CLBR of the hCG group remained comparable with that of the dual-trigger group (HR = 0.83; 95% CI 0.53-4.11; P = 0.39). The subgroup analysis also showed similar findings.
CONCLUSION
Considering the higher fertilization rate and shorter TTLB, the dual-trigger protocol may be more suitable than the hCG trigger protocol.
目的
本研究旨在比较人绒毛膜促性腺激素（hCG）和双重触发方案（促性腺激素释放激素激动剂[GnRH-a]和hCG）在高龄女性累积活产率（CLBR）及其他妊娠结局方面的疗效。
方法
我们纳入了801名年龄≥35岁的不孕女性，她们于2015年8月至2023年6月在一家三级学术医疗机构开始首次体外受精周期。其中，115名和686名女性分别采用了双重触发和hCG方法。采用倾向评分匹配法来处理混杂变量。评估的主要结局为CLBR和活产时间（TTLB）。
结果
hCG组和双重触发组的CLBR无显著差异（29.86%对26.09%，P = 0.44），而两组的TTLB相似（9.60对10.14个月，P = 0.72）。根据Kaplan-Meier分析，两组的CLBR结果相似（风险比[HR]=0.95；95%置信区间[CI] 0.63 - 1.43；P = 0.82）。在建立多因素Cox比例风险模型后，hCG组的CLBR与双重触发组仍相当（HR = 0.83；95% CI 0.53 - 4.11；P = 0.39）。亚组分析也显示了类似的结果。
结论
考虑到较高的受精率和较短的TTLB，双重触发方案可能比hCG触发方案更合适。
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