外源性药物扳机可改善卵巢功能减退患者自然周期体外受精/卵胞浆内单精子注射助孕的结局：一项倾向性评分匹配及Logistic回归分析

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Exogenous triggering with hCG/GnRHa improves outcomes of natural cycle IVF/ICSI in patients with diminished ovarian reserve： a propensity score matching and logistic regression analysis

CHANG Xinyue2，AOingning，ZHAOYan12，WANGnfeng，WANGAncong2，ZHANGHuhui²，ZHANGng，25 Deprtentedteolle's Linyi7600aKeyfosistededcodfnalofiat Reproductiedicine，HezeHospitalofaditionalineseedicine，Hee7oina

Abstract： Objective Toexplore the efects of exogenous triger （hCG/GnRHa）versus endogenous LH surge innatural cycle IVF/ICSI（NC-IVF/ICSI）forpatientswithdiminishedvarianreserve（DOR）.MethodsAretrospectiveanalysiswasconducted on1，118NC-IVF/ICSIcyclesfromtworeproductivecentersbetween2013and2024.Propensityscorematching（PSM）and multivariatelogisticregresion wereusedtoadjustforconfoundingfactors.Thetrigger-day hormone threshold was determinedusingreceiveroperatingcharacteristic （ROC）curveanalysis.Outcomemeasures includedoocyteretrievalrate， 2PNfertilizationrate，clinicalavailableembryorate，igh-qualityembryorate，freshcycleclincalpregnancyrate （R），and livebirthrate （LBR）. Results Afteradjusting forconfounders viaPSMandlogisticregresson，theexogenous triggergroup demonstrated significantlybetteroutcomesacrosalltheevaluatedparameters （oocyteretrievalate2Pfertilizationrate transferableembryorate，high-quality embryorate，freshcycleCPR，and LBR）than theendogenous LH surge group（ P⋅ <0.05）. Age-stratifiedanalysisrevealedthatfor theentirecohort，exogenous triggering significantlyincreasedthenumberof transferableembryosandhigh-qualityembryos （P<0.001） .Inthe 35-39 years old subgroup，exogenoustriggering showed significantadvantagesinoocyteyield，high-qualityembryorate，PR，and （P<0.05） and resulted in the most pronounced improvementinLBR（ OR=6.25， 95% CI：1.34-29.23）. ROC analysis establisheda decision-day LH threshold of （AUC=0.945， specificity =93.3% ）for precise stratification of the clinical pathways. Conclusion For DOR patients undergoing NC-IVF/ICSI，exogenous triggeringcomprehensivelyimprovesthetreatmentoutcomes，particularlyprovidingsignificantlive birthbenefits for womenaged35-40years.Anindividualized protocol incorporating theLHthreshold （19.055mIU/mL） effectively enhances embryonic developmental potential and live birth rates.

Keywords： diminishedovarianreserve;naturalcycleIVFICSI; ovuationtrigger; luteinizinghormone threshold;embryoquality

自1978年世界首例试管婴儿诞生以来1，辅助生殖技术，特别是体外受精（IVF）/卵胞浆内单精子注射（ICSI），彻底重塑了不孕症的治疗格局2。（剩余13169字）