两种修正达必佳长方案在IVF-ET中的应用

目的:比较两种修正的达必佳长方案在体外受精-胚胎移植(IVF-ET)和卵母细胞单精子显微注射(ICSI)中的作用。方法:将行IVF-ET和ICSI的512个治疗周期按其停用达必佳的时间分为两组,比较其在诱发排卵中的效果:A组(早停组):上次月经第21天开始隔日一次皮下注射达必佳0.1mg至Gn第4天;B组(改良组):上次月经第21天开始隔日一次皮下注射达必佳0.1mg至注射HCG日。结果:两组Gn天数、ET评分、生化妊娠率、临床妊娠率、早期流产率、OHSS发生率、LH峰发生率比较无显著性差异(P>0.05);A组达必佳支数明显少于B组(P<0.01),且受精率、卵裂率、M2卵母细胞率高于B组(P<0.01)。结论:Gn第4天停用达必佳即可有效抑制内源性LH峰,且能减少达必佳用量,获得与改良长方案相同的临床效果。

Application of two revised long protocols by triptorelin in IVF-ET

Objective:To compare the efficacy of 2 revised long protocols by triptorelin in in vitro fertilization and embryo transfer (IVF-ET) and intracytoplasmic spermatocyte injection (ICSI).Methods:512 IVF-ET/ICSI cycles were divided into 2 groups with different cessation protocols: group A (early cessation protocol): 0.1 mg triptorelin s.c. every other day starting in midluteal phase of the prior menstrual cycle (day 21), until day 4 of Gn administration; group B (modified long protocol): continued triptorelin up to and including the day of hCG injection.Results:There were no significant differences in the duration of Gn, ET score, biochemical pregnancy rate, clinical pregnancy rate, early abortion rate, incidence of ovarian hyperstimulation syndrome (OHSS) and incidence of endogenous LH surge(P>0.05). The total number of triptorelin ampoules in group A was fewer than that of group B (P<0.01), while the fertilization rate, cleavage rate and metaphase Ⅱ oocytes rate in group A were higher than those of group B (P<0.01).Conclusion:Administration of triptorelin can prevent endogenous LH peak effectively when continuing until day 4 of Gn treatment. At the same time, early cessation protocol reduces the total number of triptorelin ampoules and provides clinical effects similar to modified long protocol.