小剂量GnRHa在IVF-ET促超排卵中的探讨

目的:探讨在体外受精-胚胎移植(IVF-ET)超排卵方案中GnRHa降调节的最低有效剂量。方法:回顾分析采用长方案的148个IVF周期,分为1/2剂量组(A组)42例,每日皮下注射短效曲普瑞林1/2支(0.05mg/d);1/3剂量组(B组)44例,一次性皮下注射曲普瑞林缓释型1.25mg;小剂量组(C组)62例,每日皮下注射短效曲普瑞林1/2支(0.05mg/d)至月经来潮d3减量至1/4支(0.025mg/d),比较其治疗效果。结果:C组促性腺激素(Gn)用量、用药时间明显少于A组(P<0.05)和B组(P<0.01),hCG注射日血LH水平明显高于其他两组(P<0.05)。三组降调后E2、hCG注射日E2水平、受精率、优质胚胎率、临床妊娠率均无显著性差异(P>0.05)。三组均无内源性LH峰出现。结论:小剂量短效GnRHa的应用能减少Gn用量及缩短疗程,且不影响IVF结局,与缓释型GnRHa制剂相比还有能灵活调整使用剂量的优点。

Clinical Application of Suboptimal Dose of Triptorelin in Ovarian Stimulation for IVF-ET

Objective:To investigate the clinical efficacy of suboptimal dose of Triptorelin used in ovarian stimulation for IVF-ET.Methods:Retrospective evaluation of long protocols for those patients who were undergo-ing in vitro fertilization-embryo transfer was made.A total of 148 patients were divided into three groups.To group A,42 patients were administered with 0.05 mg Triptorelin daily;to group B,44 patients had a single dose of 1.25 mg depot Triptorelin;to group C,162 patients were administered with 0.05 mg Triptorelin daily initially but later reduced to 0.025 mg at the start of pituitary suppression.Results:The mean amount of gonadotropin was significantly lower in group C than any other two groups(25.02 ± 8.15 ampules vs 27.90 ± 7.40 ampules,P<0.05;25.02± 8.15 ampule vs 30.73±4.64 ampules,P<0.01).The length of stimulation markedly decreased in group C compared with other two groups(9.48±1.55 d vs 10.19±2.05 d,P<0.01;9.48±1.55 d vs 10.66±0.89 d,P<0.05).The LH level on the day of hCG administration was remarkably higher in the group C than any other two groups(1.70 ± 0.88 IU/L vs 1.23 ± 0.77 IU/L,P<0.05;1.70 ± 0.88 IU/L vs 0.93 ± 0.28 IU/L,P<0.05).No difference was observed among three groups in E2 levels on the day of hCG,the number of oocytes retrieved,fertilization rate,the top quality embroy rate and pregnancy rate.No premature endogenous LH surge occurred in either group.Conclusion:Suboptimal dose of Triptorelin used in IVF treatment attained same effectiveness as half and one third dose of Triptorelin,resulting in reduction of the dose of gonadotropin,the length of stimulation and the expense of treatment.