Abstract：
This study aimed to compare the effect of gonadotropin-releasing hormone agonist (GnRHa) trigger alone versus dual trigger comprising GnRHa and low-dose human chorionic gonadotropin (hCG) on reproductive outcomes in patients with polycystic ovary syndrome (PCOS) who received the freeze-all strategy.
A total of 615 cycles were included in this retrospective cohort study. Propensity score matching (PSM) was performed to control potential confounding factors between GnRHa-trigger group (0.2 mg GnRHa) and dual-trigger group (0.2 mg GnRHa plus 1000/2000 IU hCG) in a 1:1 ratio. Multivariate logistic regression was applied to estimate the association between trigger methods and reproductive outcomes.
After PSM, patients with dual trigger (n = 176) had more oocytes retrieved, mature oocytes, and 2PN embryos compared to that with GnRHa trigger alone. However, the oocytes maturation rate, normal fertilization rate, and frozen embryos between the two groups were not statistically different. The incidence of ovarian hyperstimulation syndrome (OHSS) (14.8% vs. 2.8%, P < 0.001) and moderate/severe OHSS (11.4% vs. 1.7%, P < 0.001) were significantly higher in dual-trigger group than in GnRHa-alone group. Logistic regression analysis showed the adjusted odds ratio of dual trigger was 5.971 (95% confidence interval 2.201-16.198, P < 0.001) for OHSS. The pregnancy and single neonatal outcomes were comparable between the two groups (P > 0.05).
For PCOS women with freeze-all strategy, GnRHa trigger alone decreased the risk of OHSS without damaging oocyte maturation and achieved satisfactory pregnancy outcomes.
A total of 615 cycles were included in this retrospective cohort study. Propensity score matching (PSM) was performed to control potential confounding factors between GnRHa-trigger group (0.2 mg GnRHa) and dual-trigger group (0.2 mg GnRHa plus 1000/2000 IU hCG) in a 1:1 ratio. Multivariate logistic regression was applied to estimate the association between trigger methods and reproductive outcomes.
After PSM, patients with dual trigger (n = 176) had more oocytes retrieved, mature oocytes, and 2PN embryos compared to that with GnRHa trigger alone. However, the oocytes maturation rate, normal fertilization rate, and frozen embryos between the two groups were not statistically different. The incidence of ovarian hyperstimulation syndrome (OHSS) (14.8% vs. 2.8%, P < 0.001) and moderate/severe OHSS (11.4% vs. 1.7%, P < 0.001) were significantly higher in dual-trigger group than in GnRHa-alone group. Logistic regression analysis showed the adjusted odds ratio of dual trigger was 5.971 (95% confidence interval 2.201-16.198, P < 0.001) for OHSS. The pregnancy and single neonatal outcomes were comparable between the two groups (P > 0.05).
For PCOS women with freeze-all strategy, GnRHa trigger alone decreased the risk of OHSS without damaging oocyte maturation and achieved satisfactory pregnancy outcomes.
摘要：
目的：本研究旨在比较单用促性腺激素释放激素激动剂（GnRHa）触发剂与包含GnRHa和低剂量人绒毛膜促性腺激素（hCG）的双重触发剂对多囊卵巢综合征（PCOS）患者生殖结局的影响。
方法：本回顾性队列研究共纳入615个周期。进行倾向评分匹配（PSM）以1：1的比例控制GnRHa触发组（0.2mgGnRHa）和双触发组（0.2mgGnRHa加1000/2000IUhCG）之间的潜在混杂因素。应用多变量逻辑回归估计触发方法与生殖结局之间的关联。
结果：PSM后，双重触发的患者（n=176）获得了更多的卵母细胞，成熟卵母细胞,和2PN胚胎与单独的GnRHa触发相比。然而,卵母细胞成熟率,正常受精率,而冷冻胚胎两组间差异无统计学意义。卵巢过度刺激综合征（OHSS）的发病率（14.8%vs.2.8%，P<0.001）和中度/重度OHSS（11.4%vs.1.7%,P<0.001）在双触发组中明显高于GnRHa单独组。Logistic回归分析显示,OHSS双触发因素的校正比值比为5.971(95%置信区间2.201~16.198,P<0.001)。两组妊娠结局和单胎结局具有可比性(P>0.05)。
结论：对于采用全部冻结策略的PCOS女性，单独触发GnRHa可降低OHSS的风险而不损害卵母细胞成熟，并获得满意的妊娠结局。
方法：本回顾性队列研究共纳入615个周期。进行倾向评分匹配（PSM）以1：1的比例控制GnRHa触发组（0.2mgGnRHa）和双触发组（0.2mgGnRHa加1000/2000IUhCG）之间的潜在混杂因素。应用多变量逻辑回归估计触发方法与生殖结局之间的关联。
结果：PSM后，双重触发的患者（n=176）获得了更多的卵母细胞，成熟卵母细胞,和2PN胚胎与单独的GnRHa触发相比。然而,卵母细胞成熟率,正常受精率,而冷冻胚胎两组间差异无统计学意义。卵巢过度刺激综合征（OHSS）的发病率（14.8%vs.2.8%，P<0.001）和中度/重度OHSS（11.4%vs.1.7%,P<0.001）在双触发组中明显高于GnRHa单独组。Logistic回归分析显示,OHSS双触发因素的校正比值比为5.971(95%置信区间2.201~16.198,P<0.001)。两组妊娠结局和单胎结局具有可比性(P>0.05)。
结论：对于采用全部冻结策略的PCOS女性，单独触发GnRHa可降低OHSS的风险而不损害卵母细胞成熟，并获得满意的妊娠结局。
