背景:卵巢储备功能(DOR)下降是影响接受辅助生殖治疗患者生殖结局的障碍之一。这项研究的目的是调查是否双重触发,包括促性腺激素释放激素激动剂(GnRHa)和人绒毛膜促性腺激素(hCG),使用轻度刺激方案可以改善接受体外受精(IVF)周期的DOR患者的妊娠结局。
方法:本回顾性研究共纳入734例DOR患者。根据使用的触发药物不同,将患者分为重组hCG触发组和双重触发组(hCG联合GnRHa)。主要结果指标包括回收的卵母细胞数量,受精率,可转移胚胎的数量,植入率,临床妊娠率,流产率,活产率(LBR),和累计活产率(CLBR)。对混杂因素进行了广义线性模型和逻辑回归分析。
结果:单hCG触发有337个周期,双触发有397个周期。双触发组显示出明显更多的回收卵母细胞[3.60vs.2.39,调整后的β=0.538(0.221-0.855)],受精的卵母细胞[2.55vs.1.94,调整后的β=0.277(0.031-0.523)]和可转移胚胎[1.22vs.0.95,调整后的β=0.162(-0.005-0.329)]比hCG触发组,而两组之间的受精率没有显着差异。此外,胚胎移植取消率(35.5%vs.43.9%)明显低于双触发组。在新鲜的胚胎移植周期中,植入率,临床妊娠率,两组的流产率和活产率相似。在控制了潜在的混杂变量之后,触发方法被确定为影响回收卵母细胞数量的独立因素,但对CLBR没有显著影响.
结论:hCG联合GnRHa双重触发最终卵母细胞成熟可显著增加DOR患者的卵母细胞数量,但对着床率无改善作用。临床妊娠率或新鲜周期的LBR或CLBR。
BACKGROUND: Diminished ovarian reserve (DOR) is one of the obstacles affecting the reproductive outcomes of patients receiving assisted reproductive therapy. The purpose of this study was to investigate whether dual trigger, including gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG), can improve pregnancy outcomes in patients with DOR undergoing in vitro fertilization (IVF) cycles using mild stimulation protocols.
METHODS: A total of 734 patients with DOR were included in this retrospective study. Patients were divided into a recombinant hCG trigger group and a dual trigger group (hCG combined with GnRHa) according to the different trigger drugs used. The main outcome measures included the number of oocytes retrieved, the fertilization rate, the number of transferable embryos, the implantation rate, the clinical pregnancy rate, the miscarriage rate, the live birth rate (LBR), and the cumulative live birth rate (CLBR). Generalized linear model and logistic regression analyses were performed for confounding factors.
RESULTS: There were 337 cycles with a single hCG trigger and 397 cycles with dual trigger. The dual trigger group demonstrated significantly higher numbers of retrieved oocytes [3.60 vs. 2.39, adjusted β = 0.538 (0.221-0.855)], fertilized oocytes [2.55 vs. 1.94, adjusted β = 0.277 (0.031-0.523)] and transferable embryos [1.22 vs. 0.95, adjusted β = 0.162 (-0.005-0.329)] than did the hCG trigger group, whereas no significant difference in the fertilization rate was observed between the two groups. Moreover, the embryo transfer cancellation rate (35.5% vs. 43.9%) was obviously lower in the dual trigger group. Among the fresh embryo transfer cycles, the implantation rate, clinical pregnancy rate, miscarriage rate and live birth rate were similar between the two groups. After controlling for potential confounding variables, the trigger method was identified as an independent factor affecting the number of oocytes retrieved but had no significant impact on the CLBR.
CONCLUSIONS: Dual triggering of final oocyte maturation with hCG combined with GnRHa can significantly increase the number of oocytes retrieved in patients with DOR but has no improvement effect on the implantation rate, clinical pregnancy rate or LBR of fresh cycles or on the CLBR.