生殖医学杂志

目的比较短效促性腺激素释放激素激动剂(GnRH-a)和低剂量GnRH-a长效制剂在控制性超排卵长方案中的应用效果,探讨低剂量长效GnRH-a在控制性超排卵中的应用价值。方法回顾性分析284个卵巢储备功能正常的长方案促排卵周期,其中低剂量长效组134个周期,短效GnRH-a组150个周期。对两组间垂体降调节效果、促性腺激素(Gn)使用剂量、时间、促排卵治疗中性激素的水平及IVF-ET结局进行比较。结果低剂量长效组降调节后血清黄体生成素(LH)水平[(0.95±1.58)U/L]、HCG日LH水平[(1.58±2.21)U/L]、HCG日雌二醇(E2)水平[(11 649.78±2 137.92)pmol/L]较短效组均低[分别为(1.25±1.58)U/L、(2.72±2.08)U/L)和(14 698.23±2 380.35)pmol/L],差异均有统计学意义(P<0.05);Gn总量[(34.06±8.12)支]和Gn天数[(10.43±1.25)d]较短效组[分别为(27.91±7.54)支和(9.43±1.01)d]明显升高,差异均有统计学意义(P<0.05)。两组获卵数[(10.96±2.01)vs.(11.28±2.08)枚]、MII卵数[(9.97±1.25)vs.(10.56±1.78)枚]、优胚数[(4.31±1.02)vs.(4.81±1.54)枚]、可利用胚胎率(64.81%vs.59.81%)、胚胎着床率(38.46%vs.35.34%)、临床妊娠率(55.05%vs.49.22%)、持续妊娠率(53.21%vs.47.66%)、周期取消率(2.24%vs.2.00%)以及重度卵巢过度刺激综合症(OHSS)发生率(0%vs.1.33%)等指标比较,均无统计学差异(P>0.05)。结论在控制性超排卵中,低剂量长效GnRH-a单剂量可达到与短效促性腺激素释放激素激动剂相同程度的垂体降调节状态,临床结局满意。

Objective:To compare the clinical effect of short-acting GnRH agonist(GnRH-a)with low-dose of long-acting GnRH-a in the control ovary hyperstimulating(COH)protocols,and explore the clinical value of low-dose of long-acting GnRH-a in IVF-ET.Methods:The data of 284 cycles in long down-deregulation protocol were retrospectively analyzed.Among 284 cycles,the low-dose of long-acting GnRH-a was used in 134 cycles,and short-acting GnRH-a was used in 150 cycles.The effects of pituitary down regulation,the doses and days of gonadotropin(Gn)used,the serum hormone levels during COH,and the outcomes of IVF-ET were compared between the two groups respectively.Results:The LH levels[(0.95±1.58)vs.(1.58±2.21)U/L]on the 15 th day after using GnRH-a and E2levels[(11 649.78±2 137.92)vs.(14 698.23±2 380.35)pmol/L]on the day of injection of HCG in the low-dose of long-acting GnRH-agroup were significantly lower than those in short-acting GnRH-agroup(P<0.05).The doses of Gn used [(34.06±8.12]vs.(27.91±7.54]amps](P<0.05)and the days ofusing Gn [(10.43±1.25)vs.(9.43±1.01]days]in the low-dose of long-acting GnRH-agroup were significantly more than those in short-acting GnRH-agroup(P<0.05).There were no statistic differences in the numbers of oocytes retrieved[(10.96±2.01)vs.(11.28±2.08)],MII[(9.97±1.25)vs.(10.56±1.78)],good quality embryos [(4.31±1.02)vs.(4.81±1.54)],available embryos rate(64.81% vs.59.81%),embryo implantation rate(38.46% vs.35.34%),clinical pregnancy(55.05% vs.49.22%)and persistent pregnancy(53.21% vs.47.66%),cycle cancellation rate(2.24% vs.2.00%),and occurrence of moderate or severe OHSS(0% vs.1.33%)between the two groups(all P>0.05).Conclusions:Low dose long-acting GnRH-a can get satisfactory pituitary down regulation status as short-acting GnRH-a in control ovary hyperstimulation and good clinical outcome for the patients with normal ovary reserve.