控制性超排卵长、短方案在IVF-ET中的疗效比较

目的:比较促性腺激素释放激素激动剂(GnRHa)长、短方案控制性超排卵在体外受精-胚胎移植(IVF-ET)中的疗效。方法:将2001年7月-2002年4月因双侧输卵管梗阻IVF-ET的患者100人随机分为长方案组(50人)和短方案组(50人)进行超排卵。长方案组从使用促性腺激素(Gn)治疗前1月经周期黄体期(月经21天)使用GnRHa 0.3mg/d,至垂体完全降调节后加用Gn;短方案组从月经周期第2天开始用GnRHa0.1mg/d,同时加用Gn。当患者有3个以上卵泡直径>18mm时肌肉注射人绒毛膜促性腺激素(HCG),36小时后取卵行IVF,取卵48小时后行ET。结果:两组患者平均获卵数、受精率、卵裂率、优质胚胎率、移植胚胎数、临床妊娠率、胚胎种植率及流产率差异无显著性。而两者的Gn使用量有差别,短方案组少于长方案组,两组差异有显著性。两组用Gn第7天雌激素水平不同,短方案组明显高于长方案组,两者差异有显著性。结论:GnRHa长、短方案在IVF-ET中控制性超排卵效果相同,但所需Gn数量不同。

A prospective randomized comparison of gonadotropin-releasing hormone agonist (GnRHa) long and short protocols in vitro fertilization

Objective: To compare the efficacy of gonadotropin-releasing hormone agonist (GnRHa) long and short protocols as part of controlled ovarian hyperstirnulation (COH) regimens during in vitro fertilization and embryo transfer (IVF-ET) .Methods:One hundred infertile couples accepted a prospective randomized comparative study for IVF-ET were divided into short and long treatment groups.There were fifty cases in each treatment regimen. Long protocol group:GnRHa was taken by nasal spray 0.3mg/day starting on day 21 of the previous cycle. Once the patient was down regulation,gonadotropin (Gn) was given.Short protocol group:GnRHa involved a subcutaneous use, generally given at a dose of 0. 1mg/day.The dosing commenced on day 2 of the menstrul cycle and continued each day and Gn was given on the day 3 of the cycle. Human chorionic gonadotropin (HCG) was administered when there were three or more follicles with a diameter of > 18mm, as determined by transvaginal ultrasound.Transvaginal oocyte retrieval was performed,in general,36 hours afert HCG administration. Embryo transfer was performed 48 hours after oocyte retrieval. Results: Serum estrsdiol (E2) level was lower in the long protocol group (1843 ± 897)pg/ml vs (2471 ± 989)pg/ml (P < 0.05) .Patients in short protocol group needed fewer Gn ampoules than those in long protocol group (27.5±2.77)ampoules vs (29.68 ±2.23)ampoules (P <0.05).The numbers of oocytes retrieved,fertilization rate,cleaved rate, high quality embryos rate.embroyos transfer, clinical pregnancy rate and implantation rate in a cycle were not statistically significantly different between the two groups. Conclusions: The GnRHa long and short protocols have equal effects on COH. Patients in short group needed fewer ampoules of Gn.