生殖医学杂志

目的 比较卵泡期长方案与黄体期长效长方案促排卵后鲜胚移植周期的活产率和每取卵周期累积活产率，探讨两种垂体降调节方案的优劣势。方法 回顾性分析2018年1月至2021年12月间于宁波大学附属妇女儿童医院生殖中心行体外受精-胚胎移植(IVF-ET)治疗、采用卵泡期长方案或黄体期长效长方案促排、卵巢储备功能正常患者的临床资料(共1 969个周期),并根据促排卵方案不同分为卵泡期组(使用卵泡期长方案促排卵，461个周期)和黄体期组(使用黄体期长效长方案促排卵，1 508个周期)。比较两组患者的一般情况及临床结局。结果 两组患者的女性年龄、不孕年限、体质量指数(BMI)、抗苗勒管激素(AMH)水平、不孕原因等一般资料比较均无显著性差异(P>0.05)。卵泡期组的Gn天数显著高于黄体期组[(11.0±3.3)d vs.(10.6±3.1)d](P<0.01),Gn总剂量显著低于黄体期组[(2 390.9±331.3)U vs.[(2 645.5±308.1)U](P<0.01)。两组患者的优势卵泡数、获卵数及可利用胚胎数比较均无显著性差异(P>0.05)。卵泡期组HCG日E₂、LH及P水平均显著低于黄体期组(P<0.01)。两组患者的移植日内膜厚度、移植胚胎数比较均无显著性差异(P>0.05)。卵泡期组鲜胚移植周期活产率略低于黄体期组(44.81%vs. 49.34%),差异尚无统计学意义(P=0.26)。卵泡期组的中重度卵巢过度刺激综合征(OHSS)发生率(0.87%vs. 1.59%)及每取卵周期累计活产率(68.11%vs. 70.76%)均略低于黄体期组，但差异尚无统计学意义(P>0.05)。结论 对于卵巢储备功能正常的女性，使用卵泡期长方案促排卵可获得与黄体期长方案相似的临床结局。

Objective:To compare the live birth rate per transplant cycle and cumulative live birth rate per oocyte retrieval cycle of controlled ovary hyperstimulation using long-acting long protocol in the early follicular and mid-luteal phases in order to explore the advantages and disadvantages of two kinds of pituitary down-regulation protocols.Methods:A retrospective analysis of the patients(a total of 1 969 cycles) with normal ovarian reserve function who underwent IVF-ET in Reproductive Center of Ningbo University Affiliated Women and Children's Hospital from January 2018 to December 2021. According to different ovulation protocols, these patients were grouped into early follicular group(receiving long-acting long protocol in early follicular phase, 461 cycles) and luteal phase group(receiving long-acting long protocol in the mid-luteal phase, 1 508 cycles). Basic characteristics and clinical outcomes of the two groups were compared.Results:There were no significant differences in basic characteristics of the two controlled ovarian stimulation protocol, such as age, infertility years, body mass index(BMI),anti-Müllerian hormone(AMH) level, and the cause of infertility(P>0.05). The average gonadotropin(Gn) day of the early follicular group was higher than those of the luteal phase group[(11.0±3.3) days vs.(10.6±3.1) days, P<0.01)]. The average Gn doses in the early follicular group were lower than those of the luteal phase group[(2 390.9±331.3) U vs.(2 645.5±308.1) U,P<0.01)]. There were no significant differences in average number of dominant follicles, the numbers of eggs retrieved and available embryos between the two groups(P>0.05). The average levels of estradiol(E₂),LH and progesterone in the peripheral blood of the early follicular group were significantly lower than those in the luteal phase group(P<0.01). There were no significant differences in endometrial thickness on the day of transplantation and the number of transplant embryos between the two groups(P>0.05). The live birth rate in fresh transplant cycle of the early follicular group was lower than that of the luteal phase group, showing no significant difference(44.81% vs. 49.34%,P=0.26). In the early follicular group, both the incidence of moderate or severe OHSS and cumulative live birth rate were lower than those of the luteal phase group, showing no significant differences(0.87% vs. 1.59%,68.11% vs 70.76%,P>0.05).Conclusions:The clinical outcome of long-acting long protocol in the early follicular phase is similar to that in mid-luteal phase in patients with normal ovarian reserve function.