来曲唑/FSH促排卵中GnRHa与hCG诱发卵泡成熟效果的比较

目的:比较曲普瑞林和hCG在来曲唑(LE)/FSH促排卵行IVF-ET治疗中诱发卵泡成熟的效果。方法:391个IVF-ET治疗周期随机分成促性腺激素激动剂(GnRHa)组(n=267)和hCG组(n=124),所有患者均采用LE/FSH促排卵方案,当主导卵泡平均直径达18～20mm时,GnRHa组患者采用达菲林0.1mg诱导卵泡成熟,hCG组采用hCG10000IU诱导卵泡成熟,比较组间的获卵数、MII卵率、受精率、卵裂率、优胚率、临床妊娠率和中-重度卵巢过度刺激综合症(OHSS)发生率。同时比较两组患者诱导日(d0)、取卵日(d2)、胚胎移植前日(d4)和胚胎移植后第4日(d9)的血清E2、P、LH水平。结果:hCG组Gn使用总量、MII卵率、卵裂率、中-重度OHSS发生率显著高于GnRHa组(P<0.05)。Gn使用天数、获卵数、受精率、种植率、临床妊娠率、流产率组间无统计学差异(P>0.05)。GnRHa组d0LH、d2LH、d9LH水平显著高于hCG组(P<0.05),而d2P、d4E2、d4P、d4LH、d9E2、d9P水平显著低于hCG组(P<0.05)。结论:在LE/FSH促排卵方案中可以用GnRHa替代hCG诱导卵泡成熟,而不影响IVF结局,并显著降低OHSS发生率。GnRHa诱导卵泡成熟的IVF周期其黄体期存在黄体功能不全,需适当补充外源性hCG加强黄体支持。

Comparing the Effects of GnRHa and hCG for Trigger Ovulation in Letrozole/FSH Stimulation Protocol

Objective:To compare the effects of triptorelin and hCG for trigger final oocyte maturation in letrozole(LE)/FSH stimulation protocol cycles.Methods:A total of 391 IVF-ET cycles stimulated with LE/FSH protocol were triggered with hCG 10 000 IU(hCG group,n=124) or triptorelin 0.1 mg(GnRHa group,n=267).Number of oocytes retrieved,fertilization rate,clinical pregnancy,implantation rates and incidence of moderate/severe OHSS were compared.Hormonal characteristics on the trigger day(d 0),d 2,d 4 and d 9 were also compared.Results:The total dose of Gn,MII percent,oocyte cleave rate and moderate/severe OHSS in hCG group were significantly higher than those in the GnRHa group(P<0.05).No significant differences were found in the fertilization rate,clinical pregnancy,and implantation rates between the two groups(P>0.05).The levels of LH on d 0,d 2,d 9 were significantly higher in GnRHa group than in hCG group(P<0.05),while the levels of P on d 2,d 4 E2,d 4 P,d 4 LH,d 9 E2,d 9 P were significantly lower(P<0.05).Conclusion:GnRHa can replace hCG to trigger for final oocyte maturation in letrozole stimulation protocol cycles without negative effect on outcome of IVF-ET but significantly reduce incidence of moderate/severe OHSS.Extra hCG may be needed to support luteal function in the IVF-ET cycle triggered for oocyte maturation with GnRHa which lead to the lower E2 and P in the luteal phase.