长方案使用短效GnRHa未完全降调节联合应用长效GnRHa的体外受精-胚胎移植结局分析  

Analysis outcome of combination of long-acting GnRHa for insufficient down-regulation following short-acting GnRHa in the long protocol for IVF-ET

作　　者：樊琳琳[1] 张莹莹[1] 苏迎春[1] 孙莹璞[1] 郭艺红[1] 孔慧娟[1] 

机构地区：[1]郑州大学第一附属医院生殖医学中心,郑州450052

出　　处：《现代妇产科进展》2012年第6期431-434,共4页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨长方案控制性超排卵(COH)短效醋酸曲普瑞林(Gn-RHa,0.1mg/支)未完全降调节,联合应用长效GnRHa对体外受精-胚胎移植(IVF-ET)结局影响。方法:回顾性分析本中心采用IVF-ET助孕长方案降调节治疗96个周期,根据用药后是否达到降调节标准,分为达标组(A组,n=72例)、未达标组(B组,n=24例);未达标组为避免取消周期,继续采用长效GnRHa(3.75或1.875mg)再降调节16～18天后行超促排卵治疗,分析两组超促排卵情况以及妊娠结局。结果:B组短效GnRHa降调节14天后FSH、E2、P、内膜厚度未达到降调节标准,结果均高于A组及B组补救长效GnRHa降调节后(P<0.05);B组(补救后)LH、E2低于A组,差异有显著性(P<0.05)。B组Gn天数、用量高于A组(P<0.05);B组HCG日LH、E2、≥14mm卵泡数、平均获卵数均低于A组(P<0.05);两组MⅡ率、受精率、优胚率、种植率、临床妊娠率、流产率,取消周期率,OHSS率无显著性差异(P>0.05)。结论:长方案短效GnRHa降调节未达标准者,于本周期内行长效GnRHa再次降调节,降低了周期取消率,仍可达到较高妊娠率。Objective：To investigate outcome of combination of long-acting GnRHa for insufficient down-regulation following short-acting GnRHa within 14 days in the long protocol for IVF-ET.Methods：A retrospective analysis was performed on a total of 96 cycles with the long protocol.All patients were divided into two groups according to whether reaching the pituitary down regulation criterion：criterion-achieved group（group A,n=72 cases）and not criterion-achieved group（group B,n=24 cases）.Patients of group B who refuse to cancel present cycle require to adopt long-acting GnRHa（3.75/1.875mg）to continue with hypophysis desensitization for 16~18 days before starting ovarian stimulation.Comparison was performed in the aspects of controlled ovarian hyperstimulation and pregnancy outcome between the two groups.Results：Group B with short-acting GnRHa within 14 days do not reaching the pituitary down regulation criterion because of FSH,E2,P and thickness of endometrium,higher than group A and group B following long-acting GnRHa（P0.05）.Compared with group A,the level of LH,E2 in group B after long-acting GnRHa were lower（P0.05）.Compared with group A,the duration and dosage of gonadotropin of group B were higher（P0.05）.In group B,the level of LH,E2and the No.of follicles ≥14mm on the day of hCG administration and average No.of retrieved oocytes were lower than those of group A（P0.05）.The MⅡ,fertilization,good quality embryo,implantation,clinical pregnancy,abortion,cancelled cycle and OHSS rates in the group A and group B are not statistically significant different（P0.05）.Conclusion：Patients who are insufficient down-regulation following short-acting GnRHa in the long protocol adopt long-acting GnRHa to continue with hypophysis desensitization for the present cycle,which can reduce cancelled cycle rate and maintain higher clinical pregnancy rate.

关 键 词：降调节 促性腺激素释放激素激动剂 降调标准 控制性超排卵 

分 类 号：R321[医药卫生—人体解剖和组织胚胎学]