GnRH-a长方案和GnRH-ant方案在高龄患者IVF-ET中应用效果的比较

目的比较高龄患者应用促性腺激素释放激素激动剂（GnRH-a）长方案和促性腺激素释放激素拮抗剂（GnRH-ant）方案行体外受精-胚胎移植（in vitro fertilization-embryo transfer,IVF-ET）的疗效,探讨适合高龄患者控制性卵巢刺激的方案。方法回顾性分析2007年1月至2010年6月156例高生育年龄（35～40岁）不孕症女性在南方医科大学南方医院生殖医学中心行IVF-ET的临床资料,评估GnRH-a长方案和GnRH-ant方案的助孕效果。结果 GnRH-a长方案组和GnRH-ant方案组患者的促性腺激素（Gn）应用总量及hCG日孕激素（P）水平比较,差异无统计学意义（P〉0.05）;但两组在Gn应用时间、hCG日雌二醇（E2）水平、hCG日子宫内膜厚度、获卵数、成熟卵子数、受精数和2PN数比较,差异有统计学意义（P〈0.01）;同时,两组的hCG日黄体生成素（LH）水平比较,差异有统计学意义（P〈0.05）;GnRH-a长方案组的临床妊娠率和着床率显著高于GnRH-ant方案组（P〈0.001）。结论高生育年龄患者IVF-ET中应用GnRH-a长方案的助孕结局优于GnRH-ant方案。

Comparison of GnRH- agonist long protocol with GnRH- antagonist protocol in women with advanced reproductive - age undergoing IVF- ET

Objective To explore a better effect of controlled ovarian stimulation protocol on infertile women with advanced reproductive age by comparing gonadotropin-eleasing hormone agonist (GnRH-a)long protocol with gonadotropin-releasing hormone antagonist (GnRH-ant)protocol during in vitro fertilization-embryo transfer (IVF-ET). Methods A retrospective analysis has been conducted on 156 infertile women (35～40 years old) who underwent IVF-ET in the Centre of Nanfang Hospital,Southern Medical University from January 2007 to June 2010.Results There was no significant difference between total dosage of gonodotropin (Gn)and progesterone (P)levels on day of hCG administration. However,there were significant differences among estrogen (E2)levels,thickness of endometrium on day of hCG administration and the length of gonadotropin application between GnRH-a group and GnRH-ant group(P<0.01). Meanwhile,our results showed that LH levels on day of hCG administration in GnRH-ant group were higher than that in GnRH-a group(P<0.05). The amount of retrived oocytes,matured oocytes,fertilized oocytes and normally fertilized oocytes (2PN)in GnRH-a group were higher than that in GnRH-ant group(P<0.001). The clinical pregnancy rate and the implantation rate of GnRH-a group were higher than those of GnRH-ant group(P<0.001).Conclusions The application of GnRH-a long protocol may improve the clinical outcomes of IVF-ET according to our study. The GnRH-a long protocol may be benificial for women with advanced age undergoing IVF-ET.