GnRH拮抗剂方案中西曲瑞克与加尼瑞克具有相似的抑制排卵效果和良好的妊娠结局

目的研究体外受精-胚胎移植时采用促性腺激素释放激素拮抗剂（GnRH-ant）方案中应用西曲瑞克与加尼瑞克抑制排卵效果的差异及对临床妊娠结局的影响。方法回顾性分析南方医科大学南方医院生殖中心2013 年1 月~2016 年12 月应用GnRH-ant方案促排卵患者相关资料，根据使用拮抗剂药物不同分为西曲瑞克组和加尼瑞克组，分析比较两组患者基本资料、促排卵过程及临床妊娠结局。结果本研究共纳入GnRH-ant方案2572周期，其中西曲瑞克组1368周期，加尼瑞克组1204周期。西曲瑞克组与加尼瑞克组相比，两组患者平均年龄（33.10 vs 33.89 岁，P<0.001）、体质量指数（BMI）（21.57 vs 21.84 kg/m2，P=0.024）存在统计学差异，基础卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）、孕酮（P）水平、扳机日FSH、LH、E2、P水平及平均获卵数均无统计学差异（P>0.05），但加尼瑞克组中重度卵巢过度刺激综合征（OHSS）的发生率明显高于西曲瑞克组（0.7% vs0.1%，P=0.008）。两组患者扳机日LH>10 U/L所占比例（3.7% vs 3.2%）、自发排卵率（0.6% vs 0.5%）、新鲜胚胎移植临床妊娠率（47.7% vs 45.9%）及活产率（37.5% vs 33.6%）亦无统计学差异（P>0.05）。校正患者年龄及BMI后，两组患者基础及扳机日FSH、LH、E2、P水平、平均获卵数、扳机日LH>10 U/L所占比例、自发排卵率、新鲜胚胎移植临床妊娠率及活产率均无统计学差异（P>0.05），加尼瑞克组中重度OHSS发生率仍高于西曲瑞克组（P=0.006）。结论GnRH-ant方案中应用西曲瑞克与加尼瑞克可达到相似的抑制排卵效果，扳机日LH升高发生率相同，加尼瑞克组中重度OHSS发生率略高于西曲瑞克组，但两组均获得良好的临床妊娠结局。

Effects of cetrorelix versus ganirelix in gonadotropin-releasing hormone antagonist cyclesfor preventing premature luteinizing hormone surges and on clinical outcomes of IVF-ETcycles

Objective To compare the effects of cetrorelix and ganirelix in gonadotropin-releasing hormone antagonist(GnRH-ant) cycles for preventing premature luteinizing hormone (LH) surges and on clinical outcomes of IVF-ET cycles.Methods We retrospectively analyzed 2572 GnRH-ant cycles of in vitro fertilization and embryo transfer from January, 2013 toDecember, 2016, including 1368 cycles with cetrorelix treatment and 1204 cycles with ganirelix treatment. The baselinecharacteristics of the patients and the clinical outcomes of the two groups were compared. Results Compared with thosereceiving ganirelix treatment, the patients with cetrorelix treatment had a significantly younger age (33.10 vs 33.89 years, P<0.001) and a lower body mass index (21.57 vs 21.84 kg/m2, P=0.024). After adjustment for age and body mass index of thepatients, no significant differences were found between the two groups in the levels of follicle-stimulating hormone (FSH), LH,estradiol (E2), progesterone (P) levels either at the baseline or on the day of hCG triggering, or in the number of oocytesretrieved (P>0.05). The two groups also had comparable percentages of patients with LH>10 U/L on the day of hCG triggering(3.7% vs 3.2%) and similar spontaneous ovulation rate (0.6% vs 0.5%), clinical pregnancy rate (47.7% vs 45.9%) and live birthrate (37.5% vs 33.6%) following fresh embryo transfer (P>0.05). The incidence of moderate to severe ovarian hyperstimulationsyndrome, however, was significantly higher in ganirelix group than in cetrorelix group (0.7% vs 0.1%, P=0.006). ConclusionsCetrorelix and ganirelix can achieve comparable effects for preventing premature LH surges and can achieve similar clinicaloutcomes of GnRH-ant cycles, but ganirelix is associated with a significantly higher incidence of moderate to severe ovarianhyperstimulation syndrome.