来曲唑/FSH促排卵中GnRHa与hCG诱发卵泡成熟效果的比较  

Comparing the Effects of GnRHa and hCG for Trigger Ovulation in Letrozole/FSH Stimulation Protocol

作　　者：江成龙[1] 郑蓉[2] 黄晓卉[1] 张颖[1] 胡冬玲[1] 罗丽娟[1] 张昌军[1] 

机构地区：[1]湖北医药学院附属人民医院生殖医学中心,十堰442000 [2]湖北医药学院附属太和医院妇产科,十堰442000

出　　处：《生殖与避孕》2011年第1期62-66,共5页Reproduction and Contraception

基　　金：湖北省教育厅项目;项目编号B20092411

摘　　要：目的:比较曲普瑞林和hCG在来曲唑(LE)/FSH促排卵行IVF-ET治疗中诱发卵泡成熟的效果。方法:391个IVF-ET治疗周期随机分成促性腺激素激动剂(GnRHa)组(n=267)和hCG组(n=124),所有患者均采用LE/FSH促排卵方案,当主导卵泡平均直径达18～20mm时,GnRHa组患者采用达菲林0.1mg诱导卵泡成熟,hCG组采用hCG10000IU诱导卵泡成熟,比较组间的获卵数、MII卵率、受精率、卵裂率、优胚率、临床妊娠率和中-重度卵巢过度刺激综合症(OHSS)发生率。同时比较两组患者诱导日(d0)、取卵日(d2)、胚胎移植前日(d4)和胚胎移植后第4日(d9)的血清E2、P、LH水平。结果:hCG组Gn使用总量、MII卵率、卵裂率、中-重度OHSS发生率显著高于GnRHa组(P<0.05)。Gn使用天数、获卵数、受精率、种植率、临床妊娠率、流产率组间无统计学差异(P>0.05)。GnRHa组d0LH、d2LH、d9LH水平显著高于hCG组(P<0.05),而d2P、d4E2、d4P、d4LH、d9E2、d9P水平显著低于hCG组(P<0.05)。结论:在LE/FSH促排卵方案中可以用GnRHa替代hCG诱导卵泡成熟,而不影响IVF结局,并显著降低OHSS发生率。GnRHa诱导卵泡成熟的IVF周期其黄体期存在黄体功能不全,需适当补充外源性hCG加强黄体支持。Objective：To compare the effects of triptorelin and hCG for trigger final oocyte maturation in letrozole（LE）/FSH stimulation protocol cycles.Methods：A total of 391 IVF-ET cycles stimulated with LE/FSH protocol were triggered with hCG 10 000 IU（hCG group,n=124） or triptorelin 0.1 mg（GnRHa group,n=267）.Number of oocytes retrieved,fertilization rate,clinical pregnancy,implantation rates and incidence of moderate/severe OHSS were compared.Hormonal characteristics on the trigger day（d 0）,d 2,d 4 and d 9 were also compared.Results：The total dose of Gn,MII percent,oocyte cleave rate and moderate/severe OHSS in hCG group were significantly higher than those in the GnRHa group（P0.05）.No significant differences were found in the fertilization rate,clinical pregnancy,and implantation rates between the two groups（P0.05）.The levels of LH on d 0,d 2,d 9 were significantly higher in GnRHa group than in hCG group（P0.05）,while the levels of P on d 2,d 4 E2,d 4 P,d 4 LH,d 9 E2,d 9 P were significantly lower（P0.05）.Conclusion：GnRHa can replace hCG to trigger for final oocyte maturation in letrozole stimulation protocol cycles without negative effect on outcome of IVF-ET but significantly reduce incidence of moderate/severe OHSS.Extra hCG may be needed to support luteal function in the IVF-ET cycle triggered for oocyte maturation with GnRHa which lead to the lower E2 and P in the luteal phase.

关 键 词：来曲唑(LE) GNRHA HCG 诱导排卵 

分 类 号：R714.8[医药卫生—妇产科学]