GnRH拮抗剂方案中HCG扳机时机对胚胎的影响

目的:探讨促性腺激素释放激素拮抗剂(GnRH antagonist)方案超促排卵过程中推迟人绒毛膜促性腺激素(HCG)扳机时机对胚胎质量及妊娠率等的影响。方法:回顾性分析2015年1月至12月在我院接受体外受精-胚胎移植(IVF-ET)助孕的不孕症患者183例,均采用GnRH拮抗剂促排方案,于月经周期第2天启用促性腺激素(Gn),当有卵泡平均直径达到14mm,加用GnRH拮抗剂。按照传统HCG扳机时机(有3个≥17mm卵泡)与推迟1天扳机分为2组:早期HCG组(149例)和晚期HCG组(34例),比较两组数据。结果:HCG扳机日,晚期HCG组≥15mm的卵泡数明显多于早期HCG组(P=0.026)。晚期HCG组Gn使用天数及Gn使用总量均明显高于早期HCG组(P=0.000,P=0.012)。妊娠结局方面,晚期HCG组较早期HCG组具有更高的妊娠率(76.00%vs 50.45%,P=0.020)。两组受精率、继续妊娠率、流产率、异位妊娠率均无显著差异(P0.05)。结论:GnRH拮抗剂促排方案中,适当推迟HCG扳机时间不影响胚胎质量和妊娠率,可以推行。

The effects of HCG trigger timing on embryo in GnRH antagonist protocol

Objective:To assess the effect of altering the timing of HCG administration on embryo quality and pregnancy rates in patients stimulated with recombinant FSH ( rec-FSH) and GnRH antagonist. Methods:A total of 183 infertile patients receiving in vitro fertilization and embryo transfer ( IVF-ET) in our hospital from January to December in 2015 were analyzed retrospectively. They all received GnRH antagonist protocol. Rec-FSH stimulation starting on day 2 of the cycle combined with daily GnRH antagonist starting at the day when one follicle was 14 mm on ultrasound. Patients were randomized to receive 6000 IU of HCG either as soon as at least three follicles were 17mm on ultrasound ( early-HCG group,149 patients) or 1 day later after this criterion was met (late-HCG group,34 patients). The data and outcomes were compared between the two groups. Results:On the day of HCG administration,late-HCG group has much more ≥15 mm follicles than early-HCG group ( P=0 . 026 ) . Duration of rec-FSH stimulation and total units of rec-FSH in late-HCG group is significantly higher than early-HCG group ( P=0 . 000;P=0 . 012 ) . Pregnancy rate in late-HCG group is higher than early-HCG group (76% vs 50. 45%,P=0. 020). However,fertilization rate,ongoing pregnancy rate,mis-carriage rate and ectopic pregnancy rate are similar in each group. Conclusions:In GnRH an-tagonist protocol,it is feasible to appropriately delay HCG trigger time.