适当的降调节在体外受精-胚胎移植长方案治疗中的价值

目的 探讨使用促性腺激素释放激素激动剂降调节在体外受精-胚胎移植治疗中的意义.方法 回顾分析我中心2008年1-12月185例因不孕不育接受体外受精-胚胎移植助孕的长方案治疗周期共187个.根据促性腺激素使用前患者是否达到降调标准,分为达标组(n=95)与未达标组(n=92).分析比较2组患者年龄、使用促性腺激素释放激素激动剂(gonadotrophin releasing hormone agonist,GnRH-a)和促性腺激素(gonadotropine,Gn)剂量、获卵数、成熟卵数、受精率、优质胚胎率、临床妊娠率等之间的差异.结果 2组的临床妊娠率分别为48.94%和32.61%,达标组显著高于未达标组(P<0.05);继续妊娠的观察中,二者的流产率无明显差别;达标组使用GnRH-a和Gn的剂量略大于未达标组,但两组间的差异无统计学意义.实验室资料显示两组的获卵数、MⅡ卵数以及受精率均较接近,均无明显差异(P>0.05);而在优质胚胎获得率的对比中,达标组(43.70%)明显高于未达标组(31.80%)(P<0.05).结论 在体外受精-胚胎移植的长方案治疗中,垂体降调节达标者的临床妊娠率高于未达标者.可见降调节是否充分和适当对助孕治疗的结局有重要意义.本中心现行的降调节标准是适宜的.

Value of proper pituitary down-regulation in treatment of IVF-ET

Objective To evaluate the value of pituitary down-regulation induced by gonadotrophin relea-sing hormone agonist (GnRH-a) in the outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods Totally 185 cases, which involved 187 cycles undergoing IVF/intracytoplasmic sperm injection (ICSI) treat-ment, admitted in our reproductive medicine center from Jan. to Dec. 2008 were retrospectively analyzed. All patients got triptorelin 0. 05 mg per day from mid-luteal phase of the prior menstrual cycle (dayl8 to 21 ). According to the level of pituitary down-regulation before controlling ovarian hyperstimulation ( COH ) , patients were divided into 2 groups: full-down-regulation group (group A, 95 cycles) and not full-down-regulation group ( group B, 92 cycles). Their age, doses of GnRH-a and gonadotropine (Gn) , number of retrieved oocytes and metaphase Ⅱ oocytes, fertilization rate, high quality embryos and clinic pregnancy rate were compared. Results The rate of clinic pregnancy in the group A was obviously higher than that in group B (48. 94% vs 32. 61% , P <0.05). No difference was observed in the abortion rate. Although no difference observed among the doses of GnRH-a and Gn, number of retrieved oocytes and metaphase Ⅱ oocytes and fertilization rate in 2 groups, the high quality embryos in group A was significantly higher than group B (43. 70% vs 31. 80% , P < 0.05 ). Conclusion Complete and proper pituitary down-regulation induced by GnRH-a in long protocol exerts great influence on the outcome of IVF treatment. The standard used in our reproductive center could be a good choice during the pituitary down-regulation.