生殖医学杂志

目的 比较黄体期长方案、拮抗剂方案、卵泡期长方案3种不同促排卵方案在卵巢储备功能正常患者体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕治疗中的临床结局。方法 回顾性分析我院生殖医学中心2019年1月至2023年12月收治的行IVF/ICSI-ET治疗的卵巢储备功能正常患者的临床资料，共552个周期。将纳入患者根据不同的促排卵方案进行分组：黄体期长方案组(A组，177个周期)、拮抗剂方案组(B组，291个周期)、卵泡期长方案组(C组，84个周期)。比较各组患者的一般资料、促排卵用药及获卵情况、胚胎发育及移植情况、妊娠结局。结果 3组患者间年龄、体质量指数(BMI)、不孕年限等一般资料比较均无显著性差异(P>0.05)。C组的促性腺激素(Gn)总量、Gn天数显著高于A、B组(P<0.01)，扳机日子宫内膜厚度、卵泡刺激素(FSH)水平及获卵率显著高于A、B组(P<0.01)，扳机日雌二醇(E₂)水平、黄体生成素(LH)水平、直径≥14mm卵泡数则显著低于A、B组(P<0.01)。B组的第3天(D3)优胚数、囊胚形成率、优质囊胚形成率显著高于C组(P<0.05)，可利用胚胎率及D3优胚率显著高于A、C两组(P<0.05)。A、B、C组分别进行了54、103、33个鲜胚移植周期，3组间移植胚胎数、鲜胚种植率、临床妊娠率及早期流产率、中重度卵巢过度刺激综合征发生率比较均无显著性差异(P>0.05)。结论 黄体期长方案、拮抗剂方案、卵泡期长方案均可用于卵巢储备功能正常患者，采用拮抗剂方案促排卵可以减少Gn总量及Gn使用天数，且可有效改善胚胎发育情况，但3种方案鲜胚移植的妊娠结局无明显差异。

Objectives:To compare the clinical outcomes of three different controlled ovarian stimulation(COS) protocols,namely luteal phase long protocol,antagonist protocol,and follicular phase long protocol,in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)for patients with normal ovarian reserve function.Methods:A retrospective analysis of clinical data from 552 cycles of patients with normal ovarian reserve who underwent IVF/ICSI-ET treatment at the Centre of Reproductive Medicine of Affiliated Hospital of Putian University from January 2019 to December 2023 was conducted.Patients were grouped according to different COS protocols:luteal phase long protocol group(group A,177 cycles),antagonist protocol group(group B,291 cycles),follicular phase long protocol group(group C,84 cycles).The general information,COS medication and oocyte retrieval,embryo development and embryo transfer,and pregnancy outcomes were compared among the three groups.Results:There were no significant differences in age,body mass index(BMI)and infertility duration among the three groups(P>0.05).The total amount and duration of gonadotropin(Gn)used in group C were significantly higher than those in groups A and B(P<0.01).The endometrial thickness,follicle stimulating hormone(FSH)level,and oocyte retrieval rate on human chorionic gonadotropin(HCG)day were significantly higher in group C than those in groups A and B(P<0.01).The estradiol(E₂)level,luteinizing hormone(LH)level,and the number of follicles with a diameter≥14 mm on HCG day were significantly lower in group C than those in groups A and B(P<0.01).The number of D3 high-quality embryos,blastocyst formation rate,and high-quality blastocyst formation rate in group B were significantly higher than those in group C(P<0.05),and the available embryo rate and D3 high-quality embryo rate were significantly higher than those in groups A and C(P<0.05).There were 54,103 and 33 fresh embryo transfer cycles in group A,B and C respectively.There were no significant differences in the number of transferred embryos,fresh embryo implantation rate,clinical pregnancy rate,early miscarriage rate,and the incidence of moderate to severe ovarian hyperstimulation syndrome among 3 groups(P>0.05).Conclusions:The luteal phase long protocol,antagonist protocol,and follicular phase long protocol can all be used for patients with normal ovarian reserve function,but the use of antagonist protocol for COS can reduce the total amount and duration of Gn use,and achieve better embryo development.However,no significant differences in pregnancy outcomes were found among three protocols for fresh embryo transfer.