3种长方案垂体降调节对IVF-ET结局的影响

目的:探讨3种长方案垂体降调节对体外受精-胚胎移植(IVF-ET)结局的影响。方法:752个IVF-ET周期患者分为A、B、C 3组,均行长方案降调节控制超促排卵。A组304周期应用短效促性腺激素释放激素激动剂(GnRH-a)0.05mg/d;B组218周期应用短效GnRH-a 0.1mg/d注射10～14d后改为0.05mg/d;C组230周期应用长效GnRH-a 1.25mg单次注射。比较3组促性腺激素(Gn)使用剂量、使用时间及IVF-ET结局。结果:降调时间(开始降调至Gn启动时间)B组长于C组(P<0.05),C组长于A组(P<0.05);Gn使用时间C组长于B组(P<0.05),B组长于A组(P<0.05);Gn使用总量、受精率C组多于和高于A、B两组(P<0.05);优胚率B组高于A、C组(P<0.05);临床妊娠率B、C两组差异无统计学意义(P>0.05),但均高于A组(P<0.05);中、重度卵巢过度刺激综合征(OHSS)发生率、多胎率、流产率3组间差异无统计学意义(P>0.05)。结论:增加GnRHa的使用剂量,延缓Gn启动时间可以改善IVF-ET结局,但会相应增加Gn使用剂量,增加患者治疗费用。长效GnRHa 1.25mg单次注射也可得到满意的降调节效果和临床妊娠率。

Down - regulation of three long protocols on in vitro fertilization and embryo transfer outcome

Objective ： To explore effects of three kinds of down - regulation protocols on clinical outcomes of in vitro fertiliza- tion and embryo transfer （IVF- ET）. Methods： A total of 752 women were enrolled and randomized into 3 groups prospectively. Women received 0.05 mg/d of short - acting gonadotropin - releasing hormone agonist （GnRHa） injection in group A （304 cycles）. Women in group B （218 cycles） were administered 0.1 mg/d GnRHa for 10 to 14 days , followed by 0.05 mg/d until human chorionic gonadotrophin （hCG） administration. In group C （230 cycles）, women were injected 1.25 mg of long - acting GnRHa. The mean days and dose of gonadotrophin use as well as the clinical outcome of IVF - ET were compared among the three groups. Results ： The mean down - regulation day in group B was significantly longer than that in group C （P 〈 0.05 ）, and the latter was significantly longer than that in group A （P 〈 0.05 ）. The mean day of gonadotrophin stimu- lation in group C was significantly longer than that in group B （P 〈 0.05 ）, and the latter was significantly longer than that in group A. The mean amount of gonadotrophins and fertility rate in group C were significantly higher than those in group A and group B （ P all 〈 0.05 ）. The superior quality embryo rate in group B was significantly higher than those in group A and group C （P all 〈 0.05）. No significant difference was found in the clinical pregnancy rate between group B and group C （P 〉 0. 05 ）, but both were significantly higher than that of group A （P all 〈 0.05 ）. No significant differences were found in the inci- dence rate of moderate and severe ovarian hyper - stimulation syndrome （ OHSS）, multiple gestation pregnancy rate and abor- tion rate among the three groups （ P all 〉 0.05）. Conclusion： Higher doses of GnRHa and delayed gonadotrophin stimulation could improve the clinical outcome, but higher dose of gonadotrophin results in higher payment for the treatment. A satisfacto- ry effect and clinical pregnancy rate might be obtained by use of a single dose of 1.25 mg depot GnRHa.