GnRH拮抗剂配伍HMG方案对卵巢低反应患者IVF—ET治疗结局分析

目的探讨促性腺激素释放激素拮抗剂（GnRH拮抗剂）配伍HMG方案对卵巢低反应患者控制性超排卵的效果，及其对体外受精-胚胎移植结局的影响。方法研究对象为前次IVF—ET治疗失败，证明是卵巢低反应，要求再次IVF—ET治疗的患者，随机分为2组，实验组使用GnRH拮抗剂＋HMG方案，共21个周期，对照组使用GnRH激动剂短方案，共23个周期。将两组患者的年龄、基础FSH水平、Gn使用天数和剂量、hCG日血清E2水平、获卵数、受精率、临床妊娠率、胚胎种植率等进行比较。结果两组患者不孕年限、与前次IVF—ET间隔时间、周期取消率、Gn使用天数、HCG日E2水平、获卵数、受精方式、受精率，胚胎移植数等比较差异均无显著性（P〉0．05）。拮抗剂组与激动剂组的平均年龄分别为：（37．7±3．3）岁和（35．9±4．1）岁；平均基础FSH分别为：（14．21±6．76）μ／L和（10．04±4．60）μ／L。平均Gn使用量：拮抗剂组为（32．3±17．8）支，激动剂组为（39．8±12．2）支。拮抗剂组与激动剂组的临床妊娠和胚胎种植率分别为（42．1％vs10．5％）和（25．7％vs5．0％），两组患者的年龄、基础FSH、平均Gn用量、临床妊娠率、胚胎种植率等比较差异均有显著性（P〈0．05）。结论GnRH拮抗剂与HMG配伍，对卵巢低反应的患者是一种有效的超排卵治疗方案，可以提高IVF—ET的临床妊娠率和胚胎种植率，并且费用低廉。

Gonadotropin-releasing hormone antagonist plus HMG improve the pregnancy rate of IVF-ET on poor responders

Objective To compare the effect of the treatment of gonadotrophin- releasing hormone antagonist （GnRH） plus HMG to the standard GnRH agonists short protocol for poor responders. Methods A prospective cohort study was conducted for 44 patients who had failed in previous IVF - ET treatment and were proved to be poor responders. They were randomly derided into two groups： GnRH _ ant plus HMG group which included 21 cycles using GnRH _ ant plus HMG; GnRH _ a short protocol which included 23 cycles using GnRH _ a plus rFSH＋HMG （half rFSH and half HMG） as control. Results No significant differences were found in the two groups in the infertility duration, the interval to the last IVF- ET cycle, rate of canceling cycle, days of Gn stimulating and peak estradiol level, OCCs numbers of retrival , fertility rate and embryo numbers of transferred （P〉0. 05）. The GnRH ant plus HMG group was older （37.7±3.3） vs （35.9±4.1） years, （P=0. 021）, and had higher base FSH level （14.21±6.67） vs （10. 04±4.60） （P=0. 001） than the group of GnRH _a short protocol. In contrast, less Gn was used in GnRH _ ant plus HMG group than in GnRH a short protocol group （32.3±17.8） vs （39.8±12.2） ampul, （P= 0. 018）. Higher rates of pregnancy （42.1% vs 10. 5%, P=0. 031） and implantation （25.7% vs 5.0%, P=0. 013） were found in the group of GnRH ant plus HMG than control. Conclusions The protocol of GnRH _ ant plus HMG is effective for poor responders and it is an economic protocol as well.