使用促性腺激素释放激素激动剂中发现妊娠26例分析

目的：研究在控制性超排卵(COH)使用促性腺激素释放激素激动剂(GnRH—a)的过程中发现妊娠的原因及妊娠结局。方法：回顾性分析1993年2月至2001年11月体外受精或卵母细胞浆内单精于显微注射受精与胚胎移植(IVF／ICSI—ET)超排卵周期使用GnRH—a过程中发现妊娠的临床资料。结果：在5180个IVF／ICSI—ET超排卵周期使用GnRH—a的过程中发现妊娠26例，发生率为0．50％，其中在输卵管因素、男方因素、子宫内膜异位症、盆腔粘连和不明原因各种不孕中的发生率分别为0．33％、0．37％、2．30％、0．97％和0．64％。26例妊娠中宫内妊娠20例，其中15例分娩17个健康新生儿，1例正在妊娠，流产2例，失访2例；异位妊娠6例，发生率为23．08％(6/26)，输卵管因素中异位妊娠发生率最高速55．56％(5/9)。结论：在超排卵周期使用GnRH—a的过程中应注意发生妊娠的可能。宫内妊娠给予安胎治疗，可分娩正常新生儿；此种妊娠在子宫内膜异位症患者中发生率较高，而异位妊娠发生率则在输卵管因素中最高，临床应严密监测异位妊娠的发生情况。

Analysis of 26 pregnancies during the usage of gonadotropin-releasing hormone agonist

Objective To evaluate the occurrence and outcomes of early human pregnancies exposed to gonadotropin-releasing hormone agonist (GnRH agonist).Methods The clinical data of the pregnancies(from February 1993 to November 2001)exposed to GnRH-a in in vitro fertilization or intracytoplasma sperm injection and embryo transfer(IVF/ICSI-ET) cycles was retrospectively analyzed.Results 26 cases of pregnancies were found to be exposed to GnRH agonist during their controlled ovarian hyperstimulations in 5180 IVF/ICSI-ET cycles,the incidence being 0 50%.The incidence in patients with fallopian tube factor,male factor,endometriosis,pelvic adhesion and other unknown causes were 0 33%,0 37%,2 30%,0 97% and 0 64%,respectively.Among these 26 pregnancies 20 were intrauterine gestation (15 produced 17 normal babies,2 aborted,1 is ongoing pregnancy and 2 could not be followed up).The rest 6 cases were ectopic pregnancy with a rate of 23 08%(6/26).The incidence of ectopic pregnancy in the infertile patients with fallopian tube factor was 55 56%(5/9).Conclusion There appears no increased risk of birth defects or pregnancy wastage in the pregnancies unexpectedly exposed to daily low dose GnRH-a therapy in their very early stage of gestation.Ectopic pregnancy was more common in fallopian tube factor patients.Pregnancy should be carefully monitored to exclude ectopic pregnancy.