拮抗剂与激动剂长方案促排冻胚移植临床结局分析  

The outcome of embryo transfer after GnRH antagonist protocol and subsequent frozen-thawed embryo transfer

作　　者：黄洁[1] 丁卫[1] 王媁[1] 冒韵东[1] 刘嘉茵[1] 

机构地区：[1]南京医科大学第一附属医院生殖医学科,南京210029

出　　处：《生殖医学杂志》2012年第1期21-24,共4页Journal of Reproductive Medicine

基　　金：973项目子课题(2007CB948103);江苏省卫生厅课题(H200905)资助

摘　　要：目的比较体外受精-胚胎移植周期中拮抗剂和长方案两种不同刺激方案新鲜周期及冻胚复苏周期的临床结局。方法回顾性分析2007年8月至2010年7月接受体外受精或卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗、新鲜胚胎移植周期有胚胎冷冻的妇女,应用拮抗剂方案妇女189例,应用长方案妇女936例纳入研究,将新鲜周期移植未妊娠者已接受第一次冻胚复苏移植的妇女分为两组:拮抗剂冻胚组(n=92)和长方案冻胚组(n=303),分析二者的临床结局。结果新鲜胚胎移植周期中两组基础卵泡刺激素(FSH)值、基础窦卵泡数、促性腺激素(Gn)刺激天数、Gn总用量、移植胚胎数目、优质胚胎率、流产率无统计学差异,拮抗剂组获卵数、优质胚胎数明显少于长方案组,临床妊娠率(39.2%)、继续妊娠率(36.5%)低于长方案组(分别为60%、52.5%,P=0.00);而拮抗剂冻胚组和长方案冻胚组相比,两组移植胚胎数、优质胚胎率、临床妊娠率、种植率、继续妊娠率和流产率无统计学差异。结论拮抗剂方案在新鲜刺激周期失败后有冻胚保存时,冻胚复苏周期的种植率、临床妊娠率、继续妊娠率、流产率与长方案冻胚复苏周期的结局相似,间接反映拮抗剂对于胚胎质量无不良影响。Objective： To compare the results of fresh and frozen-thawed embryos transfer following with gonado- trophin-releasing hormone （GnRH） antagonist and long GnRH agonist protocol in IVF-ET cycles. Methods： A retrospective data analysis was derived from women undergoing either IVF or ICSI with fresh embryo transfer （ET） and surplus embryos cryopreservation in our reproductive medicine department from 1 August 2007 to 31 July 2010. The outcomes of fresh embryo transfer cycles （189 antagonist cycles and 936 long agonist cycles） and frozen-thawed embryo transfer for first time from 92 antagonist cycles （GnRH antagonist group） and 303 long agonist cycles （GnRH agonist group） were evaluated. Results： In fresh embryo transfer cycles, basic FSH, basic antral follicle count （AFC）, duration of gonadotrophin （Gn） used, total amount of Gn consumed, number of embryo transferred, high-quality em- bryo rates and abortion rates were similar between antagonist cycles and long agonist cycles. However, the retrieved oocytes and high-quality embryos of the antagonist cycles were significantly less than those of the long agonist cycles. Pregnancy and ongoing pregnancy rates were significantly lower in the antagonist cy- cles than the long agonist group （39.2% vs. 60% , 36. 5% vs. 52.5%, respectively, P=0.00）. There were no significant differences in number of embryos transferred, high-quality embryo rates, pregnancy, implantation, ongoing pregnangcy, and abortion rates between the antagonist cycles and the long agonist cycles. Conclusions： Frozen-thawed embryos derived from antagonists cycles had similar outcome with those derived from long agonist cycles. It is suggested indirectly that GnRH antagonists protocol might have no an adverse effect on embryo quality.

关 键 词：促性腺激素释放激素拮抗剂 促性腺激素释放激素激动剂 冻融 胚胎 妊娠率 

分 类 号：R[医药卫生]