■这项研究的主要目的是比较使用促性腺激素释放激素(GnRH)拮抗剂方案进行体外受精(IVF)过程的不同年龄组妇女的胚胎发育和临床结局,GnRH激动剂长方案,和早期卵泡期方案。旨在为今后的临床治疗提供可靠的参考。
■我们对2021年1月至2023年2月期间接受治疗的患者进行了详细分析。1)在总体患者群体中,我们全面比较了基本特征,胚胎发育,以及用三种不同的卵巢刺激方案治疗的患者的临床结果,包括GnRH拮抗剂方案组(n=4173),激动剂长方案组(n=2410),和早期卵泡期长方案组(n=341)。2)我们将总人口分为三个年龄组,一组为30岁以下的患者(n=2576),一位30-35岁的患者(n=3249),一名为35岁以上的患者(n=1099)。然后,我们根据分组比较了三种刺激方案.我们分别比较了30岁以下患者使用三种刺激方案的胚胎发育和临床结局,30-35岁,和35岁以上的年龄组。通过这种分析,我们旨在探讨不同年龄组对不同刺激方案的反应及其对IVF成功率的影响.
■1)在总体人口中,我们发现GnRH激动剂长方案组的平均卵母细胞数明显高于GnRH拮抗剂方案组([13.85±7.162]vs.[13.36±7.862],P=0.0224),以及早期卵泡期长方案组([13.85±7.162]vs.[11.86±6.802],P<0.0001)。与其他两组相比,GnRH拮抗剂方案组的患者不仅促性腺激素(Gn)的起始剂量显着降低(P<0.05),而且Gn的使用天数也显着降低(P<0.05)。GnRH拮抗剂方案组的囊胚形成率在三组中最高。与GnRH激动剂长方案组相比显著更高(64.91%vs.62.35%,P<0.0001)和早期卵泡期长方案组(64.91%vs.61.18%,P=0.0001)。然而,不同促排卵方案治疗3组的临床妊娠率和活产率差异无统计学意义(P>0.05)。2)在<30岁年龄组,GnRH拮抗剂方案组的囊胚形成率在三组中最高,显著高于GnRH激动剂长方案组(66.12%vs.63.33%,P<0.0001)和早期卵泡期长方案组(66.12%vs.62.13%,P=0.0094)。在30-35岁年龄段,GnRH拮抗剂方案组的囊胚形成率在三组中最高,与GnRH激动剂长方案组相比显著更高(64.88%vs.62.93%,P=0.0009)和早期卵泡期长方案组(64.88%vs.60.39%,P=0.0011)。在>35岁的人群中,GnRH拮抗剂方案组的囊胚形成率明显高于GnRH激动剂长方案组(59.83%vs.56.51%,P=0.0093),而与早期卵泡期长方案组比较差异无统计学意义(P>0.05)。在三个年龄组中,我们发现临床妊娠率没有显着差异,活产率,和新生儿结局指标(胎儿体重和Apgar评分)在三种刺激方案(拮抗剂方案,GnRH激动剂长方案,和早期卵泡期长方案)(P>0.05)。研究结果表明,所有年龄段患者的临床和新生儿结局之间没有显着差异,无论卵巢刺激方案如何,提示三种卵巢刺激方案在不同年龄的患者中具有相似的治疗效果。这项研究的结果对选择合适的卵巢刺激方案和治疗结果的预测具有重要意义。
■在30岁以下和30-35岁的人群中,与GnRH激动剂长方案和早期卵泡期长方案相比,GnRH拮抗剂方案显示出更显著的优势.这表明,对于年轻和中年患者,在卵巢刺激期间,拮抗剂方案可能导致更好的结局.在35岁以上的人群中,虽然拮抗剂方案仍然优于GnRH激动剂长方案,与早期卵泡期长方案相比,没有显着差异。这可能意味着随着年龄的增长,早期卵泡期长方案可能在一定程度上具有与拮抗剂方案相似的效果.拮抗剂方案的优点在于其减少刺激持续时间和GnRH剂量的能力,同时提高患者对治疗的依从性。这意味着患者可能会发现更容易接受和坚持这种治疗方案,从而提高治疗成功率。特别是对于老年患者,使用拮抗剂方案可以显着增加胚泡形成率,这对于提高成功率至关重要。尽管在每个年龄组中使用三种方案治疗的患者的临床结果没有显着差异,仍需要进一步的研究来验证这些发现.未来的多中心研究和增加的样本量可能有助于全面评估不同刺激方案的功效。此外,需要前瞻性研究来进一步验证这些发现并确定最佳治疗策略.
UNASSIGNED: The main purpose of this study is to compare the embryo development and clinical outcomes of women in different age groups undergoing in vitro fertilization (IVF) processes using gonadotrophin-releasing hormone (GnRH) antagonist protocol, GnRH agonist long protocol, and early follicular phase protocol. We aim to provide reliable reference for future clinical treatments.
UNASSIGNED: We conducted a detailed analysis of patients who underwent treatment between January 2021 and February 2023. 1) In the overall patient population, we comprehensively compared the basic characteristics, the embryo development, and the clinical outcomes of patients treated with three different ovarian stimulation protocols, including the GnRH antagonist protocol group (n=4173), the agonist long protocol group (n=2410), and the early follicular phase long protocol group (n=341). 2) We divided the overall population into three age groups, one group for patients under 30 years old (n=2576), one for patients aged 30-35 (n=3249), and one for patients older than 35 years old (n=1099). Then, we compared the three stimulation protocols based on the group division. We separately compared the embryo development and clinical outcomes of patients using the three stimulation protocols in the under 30 years old, the 30-35 years old, and the over 35 years old age groups. With this analysis, we aimed to explore the response of different age groups to different stimulation protocols and their impact on the success rate of IVF.
UNASSIGNED: 1) In the overall population, we found that the average number of oocytes retrieved in the GnRH agonist long protocol group was significantly higher than that in the GnRH antagonist protocol group ([13.85±7.162] vs. [13.36±7.862], P=0.0224), as well as the early follicular phase long protocol group ([13.85±7.162] vs. [11.86±6.802], P<0.0001). Patients in the GnRH antagonist protocol group not only had a significantly lower starting dose of gonadotrophin (Gn) compared to the other two groups (P<0.05) but also had a significantly lower number of days of Gn use (P<0.05). The blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups, significantly higher compared to the GnRH agonist long protocol group (64.91% vs. 62.35%, P<0.0001) and the early follicular phase long protocol group (64.91% vs. 61.18%, P=0.0001). However, there were no significant differences in the clinical pregnancy rates or the live birth rates among the three groups treated with different ovarian stimulation protocols (P>0.05). 2) In the <30 age group, the blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups, significantly higher compared to the GnRH agonist long protocol group (66.12% vs. 63.33%, P<0.0001) and the early follicular phase long protocol group (66.12% vs. 62.13%, P=0.0094). In the 30-35 age group, the blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups, significantly higher compared to the GnRH agonist long protocol group (64.88% vs. 62.93%, P=0.000 9) and the early follicular phase long protocol group (64.88% vs. 60.39%, P=0.0011). In the >35 age group, the blastocyst formation rate in the GnRH antagonist protocol group was significantly higher than that in the GnRH agonist long protocol group (59.83% vs. 56.51%, P=0.0093), while there was no significant difference compared to that of the early follicular phase long protocol group (P>0.05). In the three age groups, we found that there were no significant differences in clinical pregnancy rate, live birth rate, and neonatal outcome indicators (fetal weight and Apgar score) among the three stimulation protocols (antagonist protocol, GnRH agonist long protocol, and early follicular phase long protocol) (P>0.05). The findings showed no significant differences between clinical and neonatal outcomes in patients of all ages, regardless of the ovarian stimulation protocol, suggesting that the three ovarian stimulation protocols have similar therapeutic effects in patients of different ages. The results of this study have important implications for the selection of an appropriate ovarian stimulation protocol and the prediction of treatment outcomes.
UNASSIGNED: In the younger than 30 and 30-35 age groups, the GnRH antagonist protocol showed a more significant advantage over the GnRH agonist long protocol and the early follicular phase long protocol. This suggests that for younger and middle-aged patients, the antagonist protocol may lead to better outcomes during ovarian stimulation. In the older than 35 age group, while the antagonist protocol still outperformed the GnRH agonist long protocol, there was no significant difference compared to the early follicular phase long protocol. This may imply that with increasing age, the early follicular phase long protocol may have effects similar to the antagonist protocol to some extent. The advantages of the antagonist protocol lie in its ability to reduce stimulation duration and the dosage of GnRH, while enhancing patient compliance with treatment. This means that patients may find it easier to accept and adhere to this treatment protocol, thereby improving treatment success rates. Particularly for older patients, the use of the antagonist protocol may significantly increase the blastocyst formation rate, which is crucial for improving the success rates. Although there were no significant differences in the clinical outcomes of patients treated with the three protocols in each age group, further research is still needed to validate these findings. Future multicenter studies and increased sample sizes may help comprehensively assess the efficacy of different stimulation protocols. Additionally, prospective studies are needed to further validate these findings and determine the optimal treatment strategies.