促性腺激素释放激素激动剂超长方案提高中重度子宫内膜异位症患者辅助生殖技术妊娠率

目的 探讨促性腺激素释放激素激动剂(GnRH-a)超长方案降调节对中重度子宫内膜异位症患者体外受精-胚胎移植(IVF-ET)胚胎种植率和临床妊娠率的影响.方法 回顾性分析2012年6月-2016年7月在第二军医大学长海医院生殖医学中心采用IVF-ET助孕的120例子宫内膜异位症患者的临床资料,患者行IVF-ET助孕时分别选择GnRH-a超长方案(n=42)、长方案(n=38)或短方案(n=40).分析比较:(1)3组患者的年龄,不孕年限,基础卵泡刺激素、促黄体生成素(LH)和雌二醇(E2)的水平,以及人绒毛膜促性腺激素(hCG)日LH、E2和孕酮的水平;(2)3组患者的平均取卵数、MⅡ卵子数、受精率、卵裂率、可用胚胎数、胚胎种植率和临床妊娠率.结果 (1)3组患者一般资料差异无统计学意义.(2)超长方案和长方案组患者hCG日的LH和孕酮水平均低于短方案组(P均＜0.05).(3)超长方案组患者的受精率、卵裂率、胚胎种植率和临床妊娠率均高于短方案组(P＜0.05).结论 中重度子宫内膜异位症患者在腹腔镜或开腹手术切除病灶后,行IVF-ET助孕时应用超长方案可提高临床妊娠率与胚胎种植率.

Gonadotropin-releasing hormone agonist super-long protocol elevates pregnancy rate of assisted reproductive technique in patients with moderate-to-severe endometriosis

Objective To explore the impact of gonadotropin-releasing hormone agonist (GnRH-a) super-long protocol on embryo implantation rate and clinical pregnancy rate of in vitro fertilization and embryo transfer (IVF-ET) in patients with moderate-to-severe endometriosis.Methods This retrospective study included 120 women with endometriosis who received IVF-ET from Jun.2012 to Jul.2016 in Reproductive Medical Center of Changhai Hospital of Second Military Medical University.Among the 120 patients,42 received super-long GnRH-a protocol,38 received long GnRH-a protocol,and 40 received short GnRH-a protocol during IVF-ET.We compared:(1) The patients' age,infertility years,basal serum levels of follicle stimulating hormone (FSH),luteinizing hormone (LH) and estradiol (E2),and the levels of FSH,LH,F2 and progesterone on the human chorionic gonadotropin hCG day;(2) the average number of retrieved oocyte,fertilization rate,cleavage rate,number of available embryos,embryo implantation rate and clinical pregnancy rate.Results (1) There was no significant difference in general characteristics between three protocols.(2) Compared with the short GnRH-a protocol group,the super-long GnRH-a protocol and long GnRH-a protocol had significantly decrease serum LH and progesterone levels on the hCG day (all P＜ 0.05).(3) The fertilization rate,cleavage rate,embryo implantation rate and clinical pregnancy rate of super-long GnRH-a protocol were significantly higher than those of the short GnRH-a protocol (P＜0.05).Conclusion The IVF-ET using super-long GnRH-a protocol can improve the embryo implantation rate and clinical pregnancy rate of the patients with moderate-to-severe endometriosis compared with using long or short GnRH-a protocol.