长、短效GnRH激动剂在控制性超排卵长方案中应用效果比较  

Comparison of the effect of short-acting and long-acting GnRH-a in IVF-ET by long protocol

作　　者：田莉[1] 吴丹[1] 沈浣[1] 

机构地区：[1]北京大学人民医院生殖医学中心,100044

出　　处：《中国妇产科临床杂志》2009年第6期413-415,453,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的通过比较短、长效两种GnRH激动剂(gonadropin releasing hormone agonist,GnRH-a)在控制性超排卵长方案中应用效果,探讨同一种药物不同剂型对体外受精-胚胎移植(in vitro fertilization andembryo transfer,IVF-ET)临床结局的影响。方法对使用长方案超排卵实施IVF-ET治疗的患者,根据使用不同剂型的GnRH激动剂,随机分成GnRH-a短效组及长效组。对两组间垂体降调节效果、促排卵过程中激素水平、促性腺激素(Gn)使用剂量、时间及IVF-ET结局进行比较。结果GnRH-a短效组与长效组相比,Gn使用天数及总剂量降低,分别为[(8.58±1.45)d,(10.17±1.4)d]和[(29.52±12.22)支,(38.83±10.95)支],差异具有统计学意义(P<0.000 1);短效组HCG日LH水平明显高于长效组,分别为[(2.56±1.71)U/L,(1.34±1.03)U/L,P<0.000 1];取卵个数低于长效组[(14.68±7.44)个,(19.46±10.60)个,P<0.005];两组间临床妊娠率、胚胎种植率及流产率,差异均无统计学意义(P>0.05),持续妊娠率在短效组明显高于长效组(52.08%,34.21%),差异有统计学意义(P<0.05)。结论在控制性超排卵长方案中应用短、长效GnRH激动剂对垂体均有满意的降调节效果,但长效GnRH-a可能对垂体产生过度抑制,导致Gn的用量增加,在超促排卵过程中LH水平过低,持续妊娠率降低。Objective To compare the outcome of two different dosage forms of GnRH - a on the long down regulation protocol of the controlled ovarian hyperstimulation （COH） in vitro fertilization and embryo transfer （IVF- ET） . Methods One hundred and thirty six cases received long protocol IVF- ET were divided into two groups： short- acting group and long- acting group. The pituitary down regulation result, the serum hormone levels, the gonadotropin dose during COH, and the outcome of IVF- ET were compared. Results Comparing with long - acting group, the days of using gonadotropin and doses in shorting- acting group were significantly lower [- （8. 58±1.45） d vs （10.17±1.4） d, （29.52±12.22） Amps vs （38.83±10. 95） Amps, P〈0. 0001]. The serum LH level on the day of HCG administration was significantly lower in the long - acting group compared with the short - acting group [- （1.34±1.03） U/L vs （2.56±1.71） U/L, P〈0. 0001]. The ongoing pregnancy rate was significantly higher in the shortacting group than that in the longacting group （52. 08% vs 34. 21%, P〈0.05）. Conelusions The effect of the two kinds of GnRH - a on pituitary down regulation was similar. The long - acting GnRH - a had a stronger suppression to pituitary thus increased days and doses of gonadotropin used during COH and decreased the rate of ongoing pregnancy compared to the short- acting GnRH - a.

关 键 词：GNRH激动剂 长方案 体外受精-胚胎移植 持续妊娠 

分 类 号：R714.8[医药卫生—妇产科学]