适当延后促排卵启动时间有利于IVF-ET结局  

Delaying the Timing of Start of Controlled Ovarian Hyperstimulation is Helpful for the Outcome of IVF-ET

作　　者：李豫峰[1] 李媛[1] 章汉望[1] 朱桂金[1] 靳镭[1] 岳静[1] 赖巧红[1] 吕艳[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院生殖中心,武汉430030

出　　处：《生殖与避孕》2008年第8期500-503,共4页Reproduction and Contraception

摘　　要：目的:探讨不同促排卵(COH)启动时间对IVF-ET结局的影响。方法:回顾性分析845个IVF-ET周期结局。分别比较过度抑制组(A组)及非过度抑制组(B组)中d3-5启动(亚组1)和d6-8启动(亚组2)的临床结局。同时比较GnRH-a降调后常规d3COH启动病例(C组)中,出现垂体过度抑制与未出现过度抑制组的临床结局。结果:C组中垂体过度抑制者与非过度抑制者相比,Gn用量、Gn刺激天数增加,获卵数、优质胚胎数、胚胎种植率、持续妊娠率低(P<0.05)。hCG注射日E2、LH下降(P<0.01)。而A组与B组的比较中均得出同样的结论:d6-8启动比d3-5启动获得更多的直径>14mm的卵泡数及获卵数,Gn用量及Gn使用天数减少,hCG注射日有更高的E2和LH水平(P均<0.05),但是2种启动时间相比获得的优质胚胎数、胚胎种植率及持续妊娠率均无统计学差异(P均>0.05)。结论:延迟COH启动时间可减少卵巢刺激时间、Gn用量,可增加>14mm卵泡数及获卵数,且不影响优质胚胎数、胚胎种植率及持续妊娠率。Objective：To evaluate the impact of timing of start of controlled ovarian hyperstimulation on the outcome of IVF-ET after long protocol down-regulation. Methods： A total of 845 IVF/ICSI-ET cycles （long protocol down-regulation） performed were analyzed. To compare the clinical outcomes of starting COH on day 3- 5 （sub-group 1） and starting it on day 6-8 （sub-group 2）, in patients with pituitary over suppression （group A） and the ones without it （group B）, respectively. Meanwhile, to compare the clinical outcome of the patients with pituitary over suppression and the ones without it after the use of GnRHa routinely starting COH on day 3 of the menstrual cycle （group C）. Results： In group C, the amount of Gn and the period of ovarian stimulation were higher in the patients with over suppression than the ones without it. While the number of the retrieved oocytes, good quality embryos, embryo implantation rate and the ongoing pregnancy rate were lower in the over suppression patients, so were the lever of E2 and LH on the day of hCG. In group A and B, the same results were calculated： the number of ≥ 14 mm follicles and retrieved oocytes in sub-group 2 were significantly higher than in sub-group l（P〈0.05）. While the number of Gonadotropin ampoules and the period for ovarian stimulation were lower in sub-group 2 than in sub-group 1 （P〈0.05）. And in sub-group 2, serum E2 and LH lever were higher on the day of injecting hCG （P〈0.05）. But concerning the clinical efficacy, no significant difference is shown between the two groups on the number of good quality embryos, embryo implantation rate and ongoing pregnancy rate （P〉0.05）. Conclusion： Appropriate delay of starting time of COH can make ovarian stimulation period and ampoules of Gn decrease, and make ≥ 14 mm follicles and retrieved oocytes increase, however, do not increase the number of good quality embryos, embryo implantation rate and ongoing pregnancy rate.

关 键 词：IVF—ET/ICSI 控制性超促排卵(COH) Gn 启动时间 

分 类 号：R714.8[医药卫生—妇产科学]