小剂量达必佳用于体外受精-胚胎移植卵巢反应欠佳患者的临床研究

目的:探讨小剂量达必佳在体外受精-胚胎移植(IVF-ET)卵巢反应欠佳患者中的应用效果。方法:选择接受IVF-ET治疗应用常规长方案促排卵获卵数4~6个,因治疗失败,3月后进行第2次IVF助孕的患者62例,第1个治疗周期每日皮下注射达必佳1支(0.1mg),第2治疗周期达必佳用量为每日1/3支(0.03mg),自身对照比较促性腺激素(Gn)用量、获卵数、受精卵数、冷冻胚胎数。结果:第2周期Gn用量明显少于第1周期(38.46±10.13支vs 44.50±13.10支,P<0.05);使用Gn前血黄体生成素(LH)水平高于第1周期(2.89±0.41IU/L vs 1.20±0.31IU/L,P<0.001);绒毛膜促性腺激素(HCG)注射日血LH、雌二醇(E2)水平高于第1周期(3.39±0.98IU/L vs 1.25±0.29IU/L,P<0.001;6032.11±1011.3pmol/L vs 4299.81±1122.40pmol/L,P<0.05);获卵数多于第1周期(6.7±0.32个vs 5.0±0.68个,P<0.05);受精卵数多于第1周期(4.9±0.85个vs 3.49±0.35个,P<0.05);冷冻胚胎数多于第1周期(2.1±0.42个vs 0.97±0.65个,P<0.05);而Gn用药时间、降调节后血E2、HCG注射日血孕酮(P)、优质胚胎率等在2个治疗周期间无统计学差异,62例患者第2个IVF周期21例妊娠。结论:对卵巢反应欠佳患者应用1/3剂量达必佳即可达到降调节的效果,且在减少Gn用量的同时,获得满意的妊娠效果。

The clinical study of optimal dose of Decapeptyle for poor ovarian response patients in IVF-ET cycles

Objective:To evaluate the effect of one-third dose of GnRHa(Gonadotrophin releasing hormone agonist) on the poor response patients in IVF-ET.Methods:Sixty-two patients who had got 4-6 oocytes in the first IVF-ET cycle accepted the second IVF-ET cycle with a long suppression protocol.Down-regulation with Decapeptyle injections was started in the midluteal phase at a dose of 0.1mg/d in the first cycle and 0.03mg/d in the second cycle respectively.The dose of Gn and the number of oocytes,zygote and frozen embryos were observed.Results:The dose of Gn in the second cycle was obviously less than that of the first cycle(38.46±10.13 ampules vs 44.50±13.10 ampules,P<0.05),the LH level before using Gn was higher than that of the first cycle(2.89±0.41IU/L vs 1.20±0.31IU/L,P<0.001),the LH and E_2 level on the day of HCG was higher than that of the first cycle(3.39+0.98IU/L vs 1.25±0.29IU/L,P<0.001;6032.11±1011.3pmol/L vs 4299.81±1122.40pmol/l,P<0.05),the number of eggs was more than that of the first cycle(6.7±0.32 vs 5.0±0.68,P<0.05),the number of fertilized eggs and frozen embryos was more than the first cycle(4.9±0.85 vs 3.49±0.35;2.1±0.42 vs 0.97±0.65,P<0.05).And the duration of using Gn,serum E_2 level after down regulation,P level on the day of HCG and high-quality embryo rate between the two cycles had not shown obvious difference.Conclusion:Down-regulation with one-third dose of Decapeptyle on the poor ovarian response patients can get better effect.A satisfactory effect of pregnancy was got with a decreased dose of Gn.