Abstract:

Objective　To compare the effects of different doses of gonadotropin (Gn) on the clinical outcomes of the Poseidon population with low prognosis when used in an antagonist protocol, and to provide a basis for individualized medication. Methods　This study was a retrospective cohort study. A total of 195 patients who underwent assisted reproductive technology (ART) assisted pregnancy treatment in the reproductive medicine department of Xi'an Gaoxin Hospital from February 2023 to February 2024 were selected. Among them, 221 oocyte retrieval cycles of patients with low prognosis according to the Poseidon criteria and using the antagonist protocol for ovulation induction were identified. The included patients were followed up for at least one year. According to the different total doses of Gn used in the antagonist protocol, the patients were divided into the low-dose group (≤3 000 U) with 124 oocyte retrieval cycles and the high-dose group (>3 000 U) with 97 oocyte retrieval cycles. The age of the low-dose group was (36.52±2.55) years; the body mass index was (22.56±4.51) kg/m²; the duration of infertility was (3.11±1.04) years. The age of the high-dose group was (36.83±3.11) years; the body mass index was (23.60±4.25) kg/m²; the duration of infertility was (2.87±1.44) years. The baseline data were compared between the two groups [age, body mass index, duration of infertility, basal follicle-stimulating hormone (bFSH), basal estradiol (bE₂), basal progesterone (bP), basal luteinizing hormone (bLH), basal testosterone (bT), basal prolactin (bPRL), and anti-Müllerian hormone (AMH)], the outcome of ovulation induction (initial dose of Gn, number of days used by Gn, total dose of Gn, number of retrieved oocytes, number of mature oocytes, fertilization rate, and quality embryo rate), and clinical outcomes [clinical pregnancy rate, live birth rate, and incidence of ovarian hyperstimulation syndrome (OHSS)]. Independent sample t test, non-parametric test, χ² test, and Fisher's exact probability method were used for statistical analysis. Results　Comparison of baseline data between the two groups showed no statistically significant differences (all P>0.05). There was no statistically significant difference in the initial dose of Gn, fertilization rate, and quality embryo rate between the two groups (all P>0.05). The number of days used by Gn, total dose of Gn, number of retrieved oocytes, and number of mature oocytes in the high-dose group were all higher than those in the low-dose group [(11.24±2.68) d vs. (10.44±3.01) d, (3 344.13±525.74) U vs. (2 431.57±642.63) U, 3.00 (2.00, 6.00) vs. 2.00 (2.00, 5.00), 3.00 (2.00, 5.00) vs. 2.00 (2.00, 4.00)] (all P<0.05). In the low-dose group, a total of 17 oocyte retrieval cycles were not carried out for embryo transfer due to the occurrence of OHSS or poor endometrial conditions. In the high-dose group, 9 oocyte retrieval cycles were not performed for embryo transfer. There was no statistically significant difference in the clinical pregnancy rate, live birth rate, and the incidence of OHSS between the two groups (all P>0.05). Conclusions　The use of high-dose Gn can increase the number of oocytes retrieved by patients, but it has no significant effect on the clinical pregnancy rate, live birth rate, or the incidence of OHSS. Although not statistically significant, it was observed that the incidence of OHSS in the high-dose Gn group was higher, suggesting that clinicians still need to be vigilant when applying it.

Key words:

Gonadotropins, Poseidon standard low prognosis, Antagonist protocol, Clinical outcomes

摘要：

目的　比较不同剂量促性腺激素（Gn）在拮抗剂方案中对波塞冬低预后人群临床结局的影响，为个体化用药提供依据。方法　本研究为回顾性队列研究。选取2023年2月至2024年2月于西安高新医院生殖医学科行辅助生殖技术（ART）助孕治疗的患者195例，筛选出符合波塞冬标准低预后人群且采用拮抗剂方案促排卵患者共221例取卵周期，对纳入患者进行至少为期1年的随访。根据拮抗剂方案所用Gn总剂量的不同，将患者分为低剂量组（≤3 000 U）124例取卵周期和高剂量组（>3 000 U）97例取卵周期。低剂量组年龄（36.52±2.55）岁；体重指数（22.56±4.51）kg/m²；不孕年限（3.11±1.04）年。高剂量组年龄（36.83±3.11）岁；体重指数（23.60±4.25）kg/m²；不孕年限（2.87±1.44）年。比较两组基线资料［年龄、体重指数、不孕年限、基础促卵泡刺激素（bFSH）、基础雌二醇（bE₂）、基础孕酮（bP）、基础黄体生成素（bLH）、基础睾酮（bT）、基础催乳素（bPRL）和抗苗勒管激素（AMH）］、促排卵结局（Gn起始剂量、Gn使用天数、Gn总剂量、获卵数、成熟卵数、受精率及优质胚胎率）、临床结局［临床妊娠率、活产率及卵巢过度刺激综合征（OHSS）发生率］。采用独立样本t检验、非参数检验、χ²检验和Fisher确切概率法进行统计学分析。结果　两组基线资料比较，差异均无统计学意义（均P>0.05）。两组Gn起始剂量、受精率、优质胚胎率比较，差异均无统计学意义（均P>0.05）。高剂量组Gn使用天数、Gn总剂量、获卵数、成熟卵数均高于低剂量组［（11.24±2.68）d比（10.44±3.01）d、（3 344.13±525.74）U比（2 431.57±642.63）U、3.00（2.00，6.00）个比2.00（2.00，5.00）个、3.00（2.00，5.00）个比2.00（2.00，4.00）个］（均P<0.05）。低剂量组共有17例取卵周期因发生OHSS或子宫内膜条件不良未进行胚胎移植，高剂量组有9例取卵周期未进行移植。两组临床妊娠率、活产率、OHSS发生率比较，差异均无统计学意义（均P>0.05）。结论　高剂量Gn的使用可提高患者获卵数，但对临床妊娠率、活产率及OHSS发生率均无显著影响。尽管未达到统计学显著性，但观察到高剂量Gn组的OHSS发生率较高，提示临床医生在应用时仍需保持警惕。

关键词: 促性腺激素, 波塞冬标准低预后, 拮抗剂方案, 临床结局