[Cumulative live birth rates per oocytes retrieved cycle: evaluation of clinical outcomes of IVF/ICSI].

Objective: Using of cumulative live birth rate (CLBR) per oocytes retrieved cycle, to assess the clinical outcomes of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) , and to explore impact factors on CLBR following utilization of all fresh and frozen embryos in one complete IVF/ICSI cycle using gonadotropin-releasing hormone (GnRH) agonist, GnRH-antagonist and clomiphene mild stimulation protocols. Methods: Of the patients who underwent IVF/ICSI from January 1st, 2014 to December 31st, 2015 in the First Affiliated Hospital, Nanjing Medical University, a total of 6 142 oocytes retrieved cycles were included. The clinical and laboratory parameters of different ovarian stimulation protocols, and the effects of the age, number of oocytes retrieved and number of embryos available on the CLBR of each oocytes retrieved cycle were analyzed. Results: The CLBR was 69.0% (2 004/2 906) in the GnRH-agonist protocol versus 67.4% (644/955) in the GnRH-antagonist protocol (P>0.05); the CLBR of clomiphene mild stimulation protocol was 53.2% (1 215/2 281) , significantly lower than those of the other two protocols (all P<0.05). The CLBR significantly decreased with age increased. When divided into four groups according to the patients' age, we found that CLBR were not statistically significant using three different protocols in the 20-25 years old group (all P>0.05). There was a strong association between the number of oocytes retrieved and embryos available on CLBR. CLBR rose significantly with an increasing number of oocytes up to 6, then the rising trend slowed down. Patients were categorized into four groups according to the number of oocytes retrieved, CLBR was significantly higher using GnRH-antagonist protocol (50.0%) than mild stimulation protocol (37.0%) in low ovarian responder (0-4 oocytes) group (P<0.05) . The CLBR were no significant difference among three protocols in normal (10-15 oocytes) and high responders (≥15 oocytes) group (all P>0.05) . The incidence rate of ovarian hyperstimulation syndrome in GnRH-agonist protocols (5.2%, 152/2 906) were significantly higher than those of GnRH-antagonist (4.4%, 42/955) and clomiphene mild stimulation protocols (1.5%, 34/2 281; all P<0.05) . Conclusions: CLBR is an important index to assess the clinical outcomes of IVF/ICSI. Age, number of oocytes retrieved and embryos available could affect CLBR obviously. According to the different age and ovarian response of patients, we should design ovarian stimulation protocols based on target oocytes number in order to get higher CLBR and reduce complications.目的： 以每取卵周期的累积活产率（CLBR）作为评价体外受精或卵母细胞胞质内单精子注射技术（IVF/ICSI）妊娠结局的指标，探讨不同卵巢刺激方案IVF/ICSI妊娠结局的影响因素。 方法： 回顾性分析2014年1月1日至2015年12月31日在南京医科大学第一附属医院接受IVF/ICSI治疗的不孕症患者，共6 142个取卵周期，分析不同卵巢刺激方案（长方案、拮抗剂方案、温和方案）的临床及实验室指标，比较患者年龄、不同获卵数、可移植胚胎数对每取卵周期CLBR的影响。 结果： （1）长方案和拮抗剂方案患者的每取卵周期CLBR分别为69.0%（2 004/2 906）和67.4%（644/955），两者比较，差异无统计学意义（P>0.05）；温和方案患者每取卵周期的CLBR为53.2%（1 215/2 281），显著低于前两者（P均<0.05）。（2）对不同年龄段的患者进行比较发现，对于20~25岁的患者，3种方案的每取卵周期CLBR均无差异（P均>0.05）；而对于26~35岁的患者，长方案和拮抗剂方案的每取卵周期CLBR均显著高于温和方案（P均<0.05）。（3）随着获卵数的增加，3种不同卵巢刺激方案患者的每取卵周期CLBR均呈上升趋势，当获卵数≥6个，每取卵周期的CLBR上升趋于平缓。按不同获卵数比较发现，在获卵数为0~4个时，拮抗剂方案每取卵周期的CLBR（50.0%）高于温和方案（37.0%）；获卵数为5~9个时，长方案和拮抗剂方案的每取卵周期CLBR（分别为66.3%、65.6%）均高于温和方案（54.5%），分别比较，差异均有统计学意义（P均<0.05）；而当获卵数≥10个时，3种不同方案的每取卵周期CLBR均无差异（P均>0.05）。（4）随着可移植胚胎数的增加，3种不同卵巢刺激方案患者每取卵周期的CLBR均呈上升趋势。（5）中~重度卵巢过度刺激综合征的发生率在长方案患者中（5.2%，152/2 906）显著高于拮抗剂方案者（4.4%，42/955），拮抗剂方案显著高于温和方案者（1.5%，34/2 281），分别比较，差异均有统计学意义（P均<0.05）。 结论： 每取卵周期的CLBR是评估IVF/ICSI妊娠结局的重要指标，与常规单个移植周期的活产率相比更能反映辅助生殖技术的助孕效能。年龄、获卵数和可移植胚胎数是影响每取卵周期CLBR的重要因素。针对不同年龄和卵巢反应的患者，应设计个体化的促排卵方案，可获得较高的每取卵周期CLBR，减少药物费用和促排卵并发症的发生风险。.