控制性超促排卵过程中扳机日直径≥17 mm卵泡占比对辅助生殖助孕结局的影响

Impact of the proportion of follicles with a diameter of ≥17 mm on trigger day on the pregnancy outcome of assisted reproductive technology during controlled ovarian hyperstimulation

摘要

目的：分析扳机日直径≥17 mm卵泡占比（直径≥17 mm卵泡数/直径≥14 mm卵泡数）对辅助生殖患者助孕结局的影响。方法：回顾性分析2018年7月至2023年9月于成都锦欣西囡妇科医院行体外受精/胞浆内单精子注射（in vitro fertilization,IVF/intracytoplasmic sperm injection,ICSI）助孕的3 848个周期。每位患者接受卵泡期长效长方案或拮抗剂方案治疗。通过直径≥17 mm卵泡占比分为A、B、C 3组（卵泡期长效长方案：A组：≤60%,B组：61%～73%,C组：>73%；拮抗剂方案：A组：≤62%,B组：63%～75%,C组：>75%），使用多因素logistic回归评估直径≥17 mm卵泡占比是否影响患者的活产率，临床妊娠率和流产率等助孕结局。结果：(1)卵泡期长效长方案：以A组为参考，多因素logistic回归分析结果显示，C组的流产风险是A组的1.700倍（95%CI=1.123～2.576;P=0.012）。此外，未发现直径≥17 mm卵泡占比对患者的活产率、卵巢过度刺激综合征（ovarian hyperstimulation syndrome,OHSS）发生率、临床妊娠率的影响。(2)拮抗剂方案：未发现直径≥17 mm卵泡占比与患者助孕结局之间存在关联。结论：对于接受卵泡期长效长方案的患者而言，扳机日直径≥17 mm卵泡占比越高，患者的流产风险越大。对于接受拮抗剂方案治疗的患者而言，未发现直径≥17 mm卵泡占比与不良妊娠结局之间的关联。

Abstract

Objective To investigate the impact of the proportion of follicles with a diameter of ≥17 mm on trigger day（follicles≥17 mm/follicles≥14 mm） on the pregnancy outcome of patients receiving assisted reproductive technology. Methods A retrospective analysis was performed for the data of 3848 cycles of in vitro fertilization/intracytoplasmic sperm injection for promoting pregnancy in Chengdu Jinxin Xinan Women’s Hospital from July 2018 to September 2023，and the patients received the long-acting long regimen or the antagonist regimen in the follicular phase. According to the proportion of follicles with a diameter of ≥17 mm，the patients were divided into groups A，B，and C（the long-acting long regimen： ≤60% for group A，61%-73% for group B，and >73% for group C；the antagonist regimen：≤62% for group A，63%-75% for group B，and >75% for group C）. A multivariate logistic regression analysis was used to assess the impact of the proportion of follicles with a diameter of ≥17 mm on the pregnancy outcomes of patients，including live birth rate，clinical pregnancy rate，and miscarriage rate. Results As for the long-acting long regimen in the follicular phase，the multivariate logistic regression analysis showed that the risk of miscarriage in group C was 1.700 times that in group A（95%CI=1.123~2.576，P=0.012），and in addition，the proportion of follicles with a diameter of ≥17 mm had no impact on live birth rate，the incidence rate of ovarian hyperstimulation syndrome，or clinical pregnancy rate. As for the antagonist regimen，no association was found between the proportion of follicles with a diameter of ≥17 mm and the pregnancy outcomes of the patients. Conclusion For the patients receiving the long-acting long regimen in the follicular phase，the risk of miscarriage increases with the increase in the proportion of follicles with a diameter of ≥17 mm on trigger day，while for the patients receiving the antagonist regimen，no association is found between the proportion of follicles with a diameter of ≥17 mm on trigger day and adverse pregnancy outcomes.

关键词

直径≥17 mm卵泡占比 / 卵泡直径 / 卵泡期长效长方案 / 拮抗剂方案 / 辅助生殖 / 助孕结局

Key words

proportion of follicles with a diameter of ≥17 mm / follicle diameter / long-acting long regimen in the follicular phase / antagonist regimen / assisted reproductive technology / assisted pregnancy outcome

基金资助

重庆市妇幼保健院资助项目(CQFYSJ01001)