促性腺激素释放激素拮抗剂方案在有卵巢低反应风险患者中的应用价值  

Gonadotropin-releasing hormone antagonist protocol in patients with risk of poor response to ovarian stimulation in IVF-ET

作　　者：孙瑜[1] 朱依敏[1] 

机构地区：[1]浙江大学医学院附属妇产科医院,浙江杭州310006

出　　处：《浙江大学学报（医学版）》2009年第3期305-310,共6页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的:评估促性腺激素释放激素拮抗剂(GnRH-ant)方案在体外受精-胚胎移植(IVF-ET)的超促排卵过程中存在卵巢低反应风险患者中的应用价值。方法:回顾性分析48例存在卵巢低反应风险的IVF-ET周期,其中24例周期使用GnRH-ant方案,24例周期使用促性腺激素释放激素激动剂(GnRH-a)长方案。比较两组的降调节天数、促排卵的时间和剂量,分析两组hCG日E2峰值、获卵数、受精率、获得胚胎数、优质胚胎数、移植新鲜胚胎数、冷冻胚胎数、新鲜胚胎移植周期胚胎着床率、新鲜胚胎移植周期临床妊娠率、胚胎复苏率、冷冻胚胎移植周期临床妊娠率、累计临床妊娠率。结果:GnRH-ant方案组所需降调节天数、促排卵天数、Gn用量均少于GnRH-a长方案组(P<0.001、<0.05、<0.05),hCG日E2峰值、获卵数低于GnRH-a长方案组(均P<0.05),但获得的胚胎数、优质胚胎数、移植新鲜胚胎数、冷冻胚胎数、新鲜胚胎移植周期胚胎着床率、新鲜胚胎移植周期临床妊娠率、胚胎复苏率、冷冻胚胎移植周期临床妊娠率、累计临床妊娠率两组无统计学差异。结论:与GnRH-a长方案相比,GnRH-ant方案用于存在卵巢低反应风险的患者可减少促排卵天数及Gn用量,虽然hCG日E2峰值及获卵数降低,但并不影响胚胎着床率和临床妊娠率。Objective： To evaluate the application of gonadotrophin-releasing hormone antagonist （GnRH ant） in patients with risk of poor response to controlled ovarian stimulation in IVF ET. Methods： Clinical data of 48 patients undergoing IVF with or without ICSI were retrospectively analyzed. Among them 24 patients were allocated to the GnRH-ant protocol and 24 to the long gonadotrophin-releasing hormone agonist （GnRH a） protocol. The duration of downregulation, duration of stimulation,amps of gonadotropin, estradiol level on hCG day, number of oocytes retrieved ,fertilization rate ,total embryos obtained ,high quality embryo obtained ,embryos transferred, embryos frozen, implantation rate per transfer, clinical pregnancy rate per transfer, embryo survival rate, clinical pregnancy rate per frozen embryos transfer and per cycle were compared between two groups. Results： The duration of down-regulation, duration of stimulation,the amps of gonadotropin were significantly lower in the antagonist group than those in agonist group （P〈0.001,〈0. 05,〈0.05）,the estradiol level on hCG day,the number of oocytes retrieved were significantly lower in the antagonist group than those in the agonist group （P〈 0. 05, 〈 0. 05）. No significant differences were noted in fertilization rate, total embryos obtained, high quality embryo obtained, embryos transferred, embryos frozen, implantation rate per transfer,clinical pregnancy rate per transfer,embryo survival rate,clinical pregnancy rate per frozen embryos transfer and per cycle. Conclusion. Compared with long GnRH-a protocol,the GnRH-ant protocol in patients with risk of poor response can reduce the dosage of gonadotropin and shorten the duration of stimulation,although the estradiol level on hCG day and the number of oocytes retrieved are lower,which does not affect the implantation rate and clinical pregnancy rate.

关 键 词：促性腺素释放激素/拮抗剂和抑制剂 超排卵 促性腺素释放激素/激动剂 受精 体外 胚胎移植 卵巢功能试验 不育 女(雌)性 卵巢/生理学 

分 类 号：R714.8[医药卫生—妇产科学]