长效促性腺激素释放激素激动剂降调时间对体外受精临床结局的影响

目的探讨长效促性腺激素释放激素激动剂(GnRH-a)垂体降调后促性腺激素(Gn)启动时间对体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析2011年1月~2012年6月本院生殖中心776个长方案IVF/卵胞浆内单精子注射(ICSI)新鲜移植周期的临床资料,按照Gn前垂体降调节的时间分为:A组8~10d,B组11~12d,C组13~15d,D组16~18d,比较各组的临床结局。结果四组间受精率、卵裂率、优质胚胎率均无统计学差异(P0.05);启动日A组雌二醇(E2)水平为(57.36±52.79)pmol/L,显著低于C、D组[(79.45±62.23)pmol/L、(85.56±74.07)pmol/L],(P0.05),A组黄体生成素(LH)为(1.85±1.36)IU/L,显著低于C组(2.16±1.11)IU/L,(P0.05);从A组到D组Gn用量分别为(28.58±8.25)支、(27.66±7.16)支、(27.30±8.23)支、(27.19±9.26)支和使用时间分别为(11.19±3.34)d、(10.99±1.58)d、(10.81±1.64)d、(10.90±1.99)d,有逐渐减少趋势,但各组间差异无统计学意义(P0.05);人绒毛膜促性腺激素(HCG)日A组LH水平(1.48±1.21)IU/L显著低于B、C、D组[(1.82±1.53)IU/L、(1.91±1.29)IU/L、(2.27±1.62)IU/L],(P0.05);A组孕酮(P)为(8.85±5.93)pmol/L,则显著高于其它3组[(6.32±3.67)pmol/L、(6.20±3.73)pmol/L、(5.53±3.23)pmol/L),(P0.05);四组临床妊娠率分别为42.37%、45.24%、52.16%和48.18%;胚胎种植率分别为25.19%、27.91%、33.06%、30.54%,组间差异均无统计学意义(P0.05);四组早期流产率分别为12.0%、13.16%、7.42%和1.89%,B组显著高于C、D组(P0.05)。结论在长效GnRH-a长方案控制性超排卵周期中,垂体降调节时间对妊娠结局有一定影响,适当延迟Gn启动时间(≥13d)有提高IVF临床妊娠率及种植率的趋势,并可降低早期流产率。

Influence of pituitary down-regulation duration with depot GnRH agonist on IVF,ET outcome

Objective： To evaluate the relationship between pituitary down-regulation duration with depot GnRH agonist and the outcome of IVF-ET. Methods： A total of 776 women undergoing IVF/ICSI with GnRH agonist long protocol and controlled ovarian stimulation in our hospital from Jan. 2011 to Jun. 2012 were enrolled in this retrospective study. All women were divided into 4 groups including group A（8-10 days）,group B（11-12 days）,group C （13-15 days）and group D （16-18 days）according to pituitary down-regulation duration. The clinical outcomes were compared among the groups. Results. There were no significant differences in the rates of fertilization, cleavage and good quality embryos among the four groups. The E2 levels in group A on the day of gonadotropin（Gn）administration （57.36±52.79 umol/L）were siunifle （85.56士74.07）pmol/L]（P%O. 05）. The LH levels in group A on that day[（1. 854.1.36）IU/L] were significantly lower than those in group C[（2.16± 1.11） IU/L-I（P%0.05）.The Gn doses used were （28. 584.8.25）ampoules, （27.66±7.16）ampoules, the durations were（ll. 194±3.34）days,（10.99±1. （27. 30±8.23） ampoules, （27. 19±9.26） ampoules,and 58）days, （10. 814±1.64）days,（10. 90±1.99）days in the four groups respectively. There were decrease tendency from group A to group D, but no significant difference were found among the four groups（P〈0.05）. On HCG administration day,LH levels in group A [（1. 48±1.21）IU/L] were significantly lower than those in the other groupsE（1.82±1.53）IU/L,（1. 91± 1.29）IU/L, （2. 27±1.62）IU/L respectively] （P〉0.05） ,while the progesterone levels in group A-（8. 854- 5.93）pmol/L] were significantly higher than the other three groupsF（6. 324-3.67）pmol/L, （6.20±3.73） pmol/L,（5.534. 3.23）mol/L respectively]. There were no significant differences in clinical pregnancy rates（42.37%, 45.24%, 52.16%, 48.18%） and implantation rates （25.19±, 27.91±, 33.06±, 30.54±） among the four groups （P 〈 0.05）, while the early miscarriage rate in group B （ 13.16 %） was significant higher than that in group C and group D（7.42 ±1.89）（P〈0. 05）. Conclusions： The duration of pituitary down-regulation under depot GnRH agonist before Gn administration in controlled ovarian hyperstimulation would influence the outcomes of IVF-ET. A lower early miscarriage rate could be obtained by appropriately prolong the pituitary down-regulation duration.