摘要
目的:探讨促排卵过程中添加重组人生长激素(r-hGH)对卵巢储备功能低下(DOR)患者体外授精-胚胎移植(IVF-ET)结局的影响,并分析妊娠结局的影响因素。方法:选择2021年1月至2022年1月徐州市中心医院拟接受IVF-ET治疗的DOR患者60例、徐州医科大学附属沭阳医院拟接受IVF-ET治疗的DOR患者36例,共计96例,采用随机数字表法分为两组,每组48例,对照组予以常规促排卵治疗,观察组促排卵过程中添加r-hGH治疗,比较两组促排卵、体外受精、胚胎移植以及妊娠相关指标。此外,根据妊娠结局将所有患者分成妊娠成功组和妊娠失败组,采用多因素Logistic回归分析IVF-ET结局的影响因素。结果:观察组胚胎种植率、临床妊娠率高于对照组(P<0.05);观察组与对照组注射重组人促卵泡激素(Gn)天数、Gn用量、人绒毛膜促性腺激素(HCG)日雌二醇(E2)水平、HCG日黄体生成素(LH)水平、HCG日子宫内膜厚度、获卵数、成熟卵数、受精率、卵裂率、可移植胚胎数、优质胚胎数、移植胚胎数、早期流产率比较差异无统计学意义(P>0.05)。单因素分析结果显示:妊娠失败组女方平均年龄大于妊娠成功组,基础卵泡刺激素(FSH)水平、IVF周期≥2个的患者比例高于妊娠成功组,促排卵应用了r-hGH的患者比例低于妊娠成功组,HCG日子宫内膜厚度小于妊娠成功组,基础窦卵泡数(AFC)个数、成熟卵数、优质胚胎数少于妊娠成功组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:女方年龄≥35岁、基础FSH≥14.40 IU/L、HCG日子宫内膜厚度<10 mm、基础AFC<5.5个是DOR患者IVF-ET妊娠失败的危险因素,而促排卵应用r-hGH治疗是保护因素(P<0.05)。结论:促排卵过程中增加r-hGH治疗可提高DOR患者IVF-ET胚胎种植率、临床妊娠率。女方年龄、基础FSH和AFC、HCG日子宫内膜厚度、r-hGH治疗均与IVF-ET妊娠结局有关。
Objective:To investigate the effect of adding recombinant human growth hormone(r-hGH)during ovulation induction on the outcome of in vitro insemination and embryo transfer(IVF-ET)in patients with diminished ovarian reserve(DOR),and to analyze the influencing factors of pregnancy outcome.Methods:96 patients who were to be treated with IVF-ET in Xuzhou Central Hospital from January 2021 to January 2022 were selected,36 DOR patients to be treated with IVF-ET in Shuyang Hospital Affiliated to Xuzhou Medical University were selected,total 96 cases.The patients were divided into two groups by random number table method,48 patients in each group.The control group was given routine ovulation induction therapy,and the observation group was treated with r-hGH during ovulation induction.The ovulation induction,in vitro fertilization,embryo transfer and pregnancy relevant indexes were compared between the two groups.In addition,all patients were divided into pregnancy success group and pregnancy failure group according to pregnancy outcome.Multivariate Logistic regression was used to analyze the influencing factors of IVF-ET outcome.Results:The embryo implantation rate and clinical pregnancy rate in the observation group were higher than those in the control group(P<0.05).There were no significant differences in the observation group and the control group in injected with recombinant human follicle stimulating hormone(Gn)days,Gn dosage,the human chorionic gonadotropin(hCG)daily estradiol(E2)level,the hCG daily luteinizing hormone(LH)level,the endometrial thickness on hCG day,the number of retrieved oocytes,the number of mature oocytes,the fertilization rate,the cleavage rate,the number of transferable embryos,the number of high-quality embryos,the number of transferred embryos and early abortion rate(P>0.05).The results of univariate analysis showed that the average age of women in the failed pregnancy group was greater than that in the successful pregnancy group,the proportion of patients with basal follicle stimulating hormone(FSH)level and IVF cycle≥2 were higher than those in the successful pregnancy group,the proportion of patients with r-hGH in ovulation induction was lower than that in the successful pregnancy group,the thickness of endometrium on hCG day was less than that in the successful pregnancy group,the number of basal sinus follicles(AFC),mature oocytes,the number of high-quality embryos were less than those in the successful pregnancy group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that the female age≥35 years,basal FSH≥14.40 IU/L,endometrial thickness<10mm on hCG day and basal AFC<5.5 were the risk factors of IVF-ET pregnancy failure in patients with DOR,while r-hGH treatment was the protective factor(P<0.05).Conclusion:The adding of r-HGH during ovulation induction can improve the embryo implantation rate and clinical pregnancy rate of patients with DOR with IVF-ET.Female age,basal FSH and AFC,intrauterine thickness on HCG days and r-HGH treatment were all associated with IVF-ET pregnancy out-comes.
作者
史爱红
曹义娟
葛志娟
焦艳
张力敏
SHI Ai-hong;CAO Yi-juan;GE Zhi-juan;JIAO Yan;ZHANG Li-min(Graduate School of Xuzhou Medical University,Xuzhou,Jiangsu,221002,China;Department of Reproductive Medicine,Shuyang Hospital Affiliated to Xuzhou Medical University,Shuyang,Jiangsu,223600,China;Reproductive Medicine Centre,Xuzhou Central Hospital,Shuyang,Jiangsu,221009,China)
出处
《现代生物医学进展》
CAS
2022年第15期2965-2970,共6页
Progress in Modern Biomedicine
基金
江苏省自然科学基金项目(BK20161169)。
关键词
生长激素
卵巢储备功能
体外授精-胚胎移植
妊娠结局
Growth hormone
Ovarian reserve function
In vitro insemination-embryo transfer
Pregnancy outcomes
