GnRH激动剂联合HCG双扳机对高龄女性IVF的影响

目的 探索促性腺激素释放激素激动剂（GnRH-a）联合人绒毛膜促性腺激素（HCG）双扳机是否有益于接受体外受精（IVF）治疗的高龄女性。方法 回顾两年来不孕高龄女性在笔者所在科室接受IVF治疗的699个周期，根据扳机用药不同分为3组，即单用HCG组、单用GnRH-a组、GnRH-a联合HCG组。比较3组间的获卵、胚胎质量、并发症等情况，并对其后续冷冻胚胎移植（FET）周期进行分析，比较3组间妊娠结局。结果 双扳机组与GnRH-a组相似，其获卵数、成熟卵数、有效胚胎数均显著多于HCG组（P=0.000），但3组间的受精率、卵裂率、有效胚胎率比较差异无统计学意义（P>0.05）。HCG组中重度卵巢过度刺激综合征（OHSS）发生率为3.07%，而其他两组中均无发生。GnRH-a组有获卵失败比例升高的趋势，但与其他两组差异无统计学意义（P>0.05）。不同扳机方式的后续FET妊娠结局间比较差异无统计学意义（P>0.05）。结论 与传统HCG或GnRH-a扳机方式比较，GnRH-a联合HCG双扳机更有利于得到更多的卵子数和成熟卵数，同时避免发生诱导排卵失败、或中重度OHSS的风险。

Effects of Double Trigger by Gonadotrophin-releasing Hormone Agonist and Human Chorionic Gonadotrophin on Advance-aged Females Receiving in vitro Fertilization Treatment

Objective To investigate whether there are benefits of double trigger by GnRH agonist and HCG on advance-aged females receiving IVF treatment. Methods The data of 699 IVF cycles in 2 years treated for 35 and above years old women were collected retrospectively. According to the differences of trigger protocol, these cycles were divided into 3 groups:HCG group, GnRH agonist (GnRH-a) group, and Double trigger group for the protocol by using GnRH-a and HCG together. Oocytes retrieved, embryo quality, complications of treatment were compared among 3 groups, as well as the pregnancy outcomes of frozen embryo transfer (FET). Results Double trigger and GnRH-a groups had the comparable number of oocytes, matured oocytes and viable embryos, which were both significantly higher than the number in HCG group (P=0.000). However the rates of fertilization, cleavage and viable embryo among 3 groups were similar (P>0.05). No moderate or severe hyperstimulation ovarian syndrome happened in Double trigger and GnRH-a groups, while the incidence in HCG group was 3.07%. GnRH-a trigger might be accompanied by a slight but not significant higher incidence of failed oocyte retrieve (P>0.05). The pregnancy outcomes of FET were comparable among 3 groups (P>0.05). Conclusion Compared with traditional trigger protocol, the Double trigger may have benefits on more retrieved oocyte and matured oocytes. Double trigger by GnRH-a and HCG may also prevent the occurrences of the failed ovulation and severe hyperstimulation ovarian syndromes.