Abstract:

Objective　To compare the effects of using down regulation protocol and gonadotropin-releasing hormone (GnRH) antagonist protocol in women with diminished ovarian reserve aged more than 40 years during in vitro fertilization-embryo transfer (IVF-ET). Methods　The clinical data of patients with diminished ovarian reserve aged more than 40 years undergoing in vitro fertilization/intracytoplasmic sperm injection - embryo transfer in Department of Reproductive Medicine, Liaocheng People's Hospital from January 2017 to May 2021 were retrospectively analyzed. A total of 142 women with 151 cycles were collected according to the inclusion criteria, and were divided into two groups according to the controlled ovulation induction protocols: a down regulation group (29 women with 31 cycles) and a GnRH antagonist group (113 women with 120 cycles). The general data, clinical treatment, laboratory data, outcomes of clinical assisted pregnancy outcomes were compared between the two groups. Independent sample t test, Wilcoxon rank sum test, Fisher exact probability method, and χ² test were used for statistical analysis. Results　There were no statistically significant differences in the age, infertility years, body mass index, basal follicle stimulating hormone (FSH), basal estradiol (E2), anti-Mullerian hormone, and antral follicle count between the two groups (t=1.204, -1.634, 0.741, -0.643, 1.491, 1.868, and 1.270; all P>0.05). The number of Gn days [(10.16±2.85) d vs. [8.60±2.79) d], blastocyst formation rate [77.78% (14/18) vs. 39.47% (15/38)], and high quality blastocyst formation rate [50.00% (9/18) vs. 13.16% (5/38)] of the down-regulation group were higher than those of the GnRH antagonist group, with statistically significant differences (t=2.722, χ²=7.177 and 8.842; all P<0.05). There were no statistically significant differences in the fertilization rate, 2PN rate, and high-quality embryo rate between the two groups (χ²=0.018, 0.662, and 2.375; all P>0.05). The clinical pregnancy rate [22.73% (5/22) vs. 11.11% (3/27)] and live birth rate [13.64% (3/22) vs. 3.70% (1/27)] of the down-regulation group were higher than those of the GnRH antagonist group, and the abortion rate of the down-regulation group was lower than that of the GnRH antagonist group [40.00% (2/5) vs. 75.00% (2/3)], but there were no statistically significant differences (all P>0.05). Conclusion　For patients with diminished ovarian reserve aged more than 40 years, the down regulation protocol has a trend to increase the clinical pregnancy rate and reduce the abortion rate.

Key words:

Diminished ovarian reserve, Down-regulation protocol, GnRH antagonist protocol, Aged more than 40 years

摘要：

目的　比较卵巢储备功能减退、高龄（≥40岁）患者在体外受精-胚胎移植周期中采用降调节方案和拮抗剂方案的应用效果。方法　回顾性分析2017年1月至2021年5月于聊城市人民医院生殖医学科行体外受精/卵胞质内单精子注射-胚胎移植助孕的≥40岁合并卵巢储备功能减退患者的临床资料，按照纳入标准共收集符合条件的142例患者均151个周期，并根据控制性促排卵方案的不同分为两组：降调组29例患者31个周期，拮抗剂组113例患者120个周期。比较两组患者的一般情况、临床治疗情况、实验室数据、临床助孕结局。统计学方法采用独立样本t检验、Wilcoxon符号秩和检验、Fisher确切概率法、χ²检验。结果　两组患者的年龄、不孕年限、体质量指数、基础卵泡刺激素、基础雌二醇、抗缪勒管激素及窦卵泡计数比较差异均无统计学意义（t=1.204、-1.634、0.741、-0.643、1.491、1.868、1.270，均P>0.05）。降调组使用促性腺激素天数［（10.16±2.85）d比（8.60±2.79）d］、囊胚形成率［77.78%（14/18）比39.47%（15/38）］、优质囊胚形成率［50.00%（9/18）比13.16%（5/38）］均高于拮抗剂组，差异均有统计学意义（t=2.722、χ²=7.177、8.842，均P<0.05）；两组受精率、双原核率、优质胚胎率比较差异均无统计学意义（χ²=0.018、0.662、2.375，均P>0.05）；降调组新鲜移植临床妊娠率［22.73%（5/22）比11.11%（3/27）］、活产率［13.64%（3/22）比3.70%（1/27）］均高于拮抗剂组，降调组流产率低于拮抗剂组［40.00%（2/5）比75.00%（2/3）］，但差异均无统计学意义（均P>0.05）。结论　对于≥40岁合并卵巢储备功能减退的高龄不孕女性，采用降调节方案有增加临床妊娠率、降低流产率的趋势。

关键词:

卵巢储备功能减退, 降调节方案, 拮抗剂方案, ≥40岁