不同预处理促性腺激素拮抗剂方案在超促排卵中应用的临床分析

目的:探讨如何在体外受精-胚胎移植(IVF-ET)周期中更有效地运用拮抗剂方案。方法:回顾性分析319个使用拮抗剂方案进行IVF-ET无输卵管积液、无内膜息肉及无子宫解剖结构异常的新鲜移植周期。根据拮抗剂治疗前使用短效激动剂(n=125,A组)、口服避孕药(达英-35)(n=113,B组)和未处理组(n=81,C组)分组,比较各组患者的年龄、促性腺激素(Gn)使用天数和剂量、注射hCG日LH和E2水平、获卵数、优质胚胎率、临床妊娠率等。同时以261个促性腺激素激动剂长方案移植周期为对照组(D组)作进一步对比。结果:C组年龄(32.9±4.8岁)较其它组年龄明显偏大,P<0.05;A和B组Gn使用剂量大于C组,其中A组明显增多(P<0.01);A和B组hCG注射日LH水平均较C组明显低,其中A组LH值最低(P<0.01);A组获卵数最多(P<0.05);B组子宫内膜最薄(P<0.01)。3组的受精率、优质胚胎率均无统计学差异(P>0.05)。A组、B组和C组临床妊娠率分别为:32.8%、17.7%和37.0%,B组临床妊娠率显著低于A、C组(P<0.01)。C组、D组间临床妊娠率比较无统计学差异(37.0%vs 40.2%,P>0.05);C组Gn使用的时间和剂量均比D组明显减少(P<0.05)。结论:在IVF-ET中GnRH拮抗剂治疗前使用达必佳预处理未能提高妊娠率,使用过达因-35避孕的患者妊娠率明显下降,而未使用任何药物的患者接受GnRH拮抗剂超促排卵方案,能获得比较好的临床结局。

Different Pretreatments before the GnRH Antagonist Protocol in the Application of Controlled Ovarian Hyperstimulation

Objective: To explore how effective to use gonadotropin-releasing hormone antagonist protocol during in vitro fertilization-embryo transfer(IVF-ET) cycles.Methods: A retrospective analysis was performed.All the ET cycles were divided into three groups,group A(n=125) used short acting GnRH agonist before GnRH antagonist treatment,group B(n=113) used short-acting oral contraceptives before GnRH antagonist treatment,group C(n=81) was untreated before GnRH antagonist treatment.The patient’s age,dose and duration of gonadotropin(Gn) treatment,the serum LH and E2 levels on the day of hCG injection,the number of oocytes retrieved,the rates of good-quality embryos,the clinical pregnancy rates were compared.At the same time,261 GnRH agonist long protocol cycles(group D) were selected at the same period as further comparison.Results: The patients in group C(32.9 ± 4.8 years) were significantly older than those in groups A and B(P<0.05).The dose and the duration of Gn in group C were significantly lower than those in groups A and B(P<0.01).The serum LH level on the day of hCG injection in group A and group B was significantly lower than that in group C(P<0.05),especially in group A(P<0.01).The endometrium was the thinnest in group B(P<0.01).There were no significant differences in the fertilization rates and the good-quality embryo rates among them(P>0.05).The clinical pregnancy rate of group B decreased significantly compared with groups A and C(P<0.01).There was no significant difference of clinical pregnancy rates between group C and group D(37.0% vs 40.2%,P>0.05).However,the dose(19.8 ± 6.6 ampoule vs 26.4 ± 8.1 ampoule) and the duration(9.0 ± 1.6 d vs 11.6 ± 2.5 d) of Gn treatment in group C were decreased significantly than those in group D,P<0.05.Conclusion: The short acting GnRH agonist used before GnRH antagonist treatment during IVF-ET cycles failed to improve the pregnancy rates,the use of short-acting oral contraceptives before GnRH antagonist treatment makes the pregnancy rates decrease significantly,but untreated before GnRH antagonist protocol can get a better clinical outcome compared with agonist long protocol.Untreated GnRH anagonist protocol is the best GnRH anagonist protocol.