| 摘要: |
| ［摘要］ 目的 探讨控制性卵巢刺激（COS）周期醋酸地塞米松（DXM）干预时机对助孕结局的影响。方法 回顾性分析2022年1月至2024年6月于中南大学湘雅医学院附属常德医院（常德市第一人民医院）生殖医学中心采用卵泡期长效长方案首次行体外受精-胚胎移植（IVF-ET）助孕的450例患者（共450个周期）的临床资料。根据DXM应用情况将其分为未添加DXM组（A组，117例）与DXM干预组（B组，333例），B组再根据DXM干预时机分为三个亚组：早期DXM组［B1组，205例，开始使用促性腺激素（Gn）时给药］、中期DXM组（B2组，54例，Gn使用6 d后或主导卵泡直径10～14 mm时给药）、晚期DXM组［B3组，74例，主导卵泡直径>16 mm或给药当日血清孕酮（P）水平≥1 ng/mL］。比较四组一般资料、COS方案、激素指标、胚胎实验室核心指标及助孕结局等。结果 四组年龄、不孕时间、体质量指数（BMI）、抗米勒管激素（AMH）以及基础促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇（E2）、P水平比较差异无统计学意义（P>0.05）。四组Gn启动剂量比较差异无统计学意义（P>0.05）。B1组Gn总量低于A组，Gn时间短于A组，差异有统计学意义（P<0.05）。在扳机日，B1组、B2组和B3组的E2水平均高于A组，并且B3组E2水平高于B1组，差异有统计学意义（P<0.05）；B3和B2组P水平显著高于A组和B1组（P<0.05）。B3组获卵数多于A组，MⅡ卵率高于B1组，可移植胚胎数多于B1组，差异有统计学意义（P<0.05）。B1组囊胚形成率低于A组，差异有统计学意义（P<0.05）。四组2PN受精率、2PN卵裂率、优质胚胎数和优质胚胎率比较差异无统计学意义（P>0.05）。A组和B1组鲜胚移植率高于B2组，A组P升高相关移植取消率低于B1组、B2组和B3组，差异有统计学意义（P<0.05）。B1组临床妊娠率（69.29%）和活产率（56.67%）最高，但四组间比较差异无统计学意义（P>0.05）。结论 在卵泡期长效长方案COS周期中，早期添加DXM可有效控制P水平，减少Gn用量及刺激天数，提高鲜胚移植率，改善助孕结局。 |
| 关键词: 醋酸地塞米松 控制性卵巢刺激 卵泡期长效长方案 孕酮 助孕结局 |
| DOI：10.3969/j.issn.1674-3806.2026.06.14 |
| 分类号:R 711.6 |
| 基金项目:湖南创新型省份建设专项（编号：2025JJ70646）；常德市科技局指导项目（编号：2024ZD246，2024ZD260） |
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| Effect of the timing of dexamethasone acetate intervention in controlled ovarian stimulation cycles on assisted pregnancy outcomes |
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ZHANG Ling1, TANG Bin1, CHENG Chong2, QIN Yaqian1, TANG Jia1, GUO Yabin1
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1.Centre for Reproductive Medicine, Changde Hospital, Xiangya School of Medicine, Central South University(the First People′s Hospital of Changde City), Changde 415000, China; 2.Department of Nuclear Medicine, Changde Hospital, Xiangya School of Medicine, Central South University(the First People′s Hospital of Changde City), Changde 415000, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effect of the timing of dexamethasone acetate(DXM) intervention in controlled ovarian stimulation(COS) cycles on assisted pregnancy outcomes. Methods A retrospective analysis was conducted on the clinical data of 450 patients(a total of 450 cycles) undergoing initial in vitro fertilization and embryo transfer(IVF-ET) by using the follicular phase long-acting long protocol in the Centre for Reproductive Medicine of Changde Hospital, Xiangya School of Medicine, Central South University(the First People′s Hospital of Changde City) from January 2022 to June 2024. The patients were divided into non-DXM group(group A, 117 cases) and DXM intervention group(group B, 333 cases). Group B was further subdivided into three subgroups according to the timing of DXM intervention: early-stage DXM group［group B1, 205 cases, DXM was administered at the initiation of using gonadotropin(Gn)］, mid-stage DXM group(group B2, 54 cases, DXM was administered at 6 days after using Gn or when the diameter of dominant follicles was 10-14 mm), and late-stage DXM group［group B3, 74 cases, DXM was administered when the diameter of dominant follicles was >16 mm or DXM was administered when serum progesterone(P) level was ≥1 ng/mL］. The general data, COS protocols, hormonal parameters, core embryonic laboratory indicators, and assisted pregnancy outcomes were compared among the four groups. Results There were no significant differences among the four groups in age, infertility duration, body mass index(BMI), anti-Müllerian hormone(AMH), and baseline levels of follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2) and P(P>0.05). There was no statistically significant difference in Gn starting dose(GSD) among the four groups(P>0.05). The total Gn dose in group B1 was significantly lower than that in group A, and the duration of using Gn in group B1 was significantly shorter than that in group A, with statistically significant differences(P<0.05). On the trigger day, the E2 levels in group B1, group B2 and group B3 were higher than those in group A, and the E2 level in group B3 was significantly higher than that in group B1, with statistically significant differences(P<0.05). The P levels in group B3 and group B2 were significantly higher than those in group A and group B1(P<0.05). Group B3 had a higher number of oocytes retrieved than group A, and a higher rate of metaphase Ⅱ(MⅡ) oocytes than group B1, and a higher number of transferable embryos than group B1, with statistically significant differences(P<0.05). The blastocyst formation rate in group B1 was lower than that in group A, with statistically significant difference(P<0.05). There were no significant differences among the four groups in the two-pronuclear zygote(2PN) fertilization rate, 2PN cleavage rate, number of top-quality embryos and top-quality embryo rate(P>0.05). The rate of fresh embryo transfer was higher in group A and group B1 than in group B2, and the cycle cancellation rate due to elevated P was lower in group A than in group B1, group B2, and group B3, with statistically significant differences(P<0.05). Group B1 had the highest clinical pregnancy rate(69.29%) and live birth rate(56.67%), but the differences among the four groups were not statistically significant(P>0.05). Conclusion In COS cycles using the follicular phase long-acting long protocol, adding DXM at early stage can effectively control P levels, reduce Gn dosage and days of stimulation, and increase the rate of fresh embryo transfer, thereby improving the assisted pregnancy outcomes. |
| Key words: Dexamethasone acetate(DXM) Controlled ovarian stimulation(COS) Follicular phase long-acting long protocol Progesterone Assisted pregnancy outcomes |
