长短效GnRHa降调节方案与卵泡发育同步化  

Effect of Long and Short-acting GnRHa Down-regulation Protocols on Follicular Synchronization and Outcomes

作　　者：冯月枝[1] 何钻玉[1] 陈菁特[1] 于文昶[1] 李予[1] 王文军[1] 杨冬梓[1] 张清学[1] 

机构地区：[1]中山大学孙逸仙纪念医院生殖中心,广东广州510120

出　　处：《中山大学学报（医学科学版）》2013年第2期280-286,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(S2011010004662)

摘　　要：【目的】研究不同剂量长效和短效GnRHa长方案对卵泡发育同步化及妊娠结局的影响。【方法】回顾性分析2011年至2012年于我中心行长效和短效GnRHa长方案IVF/ICSI治疗的859例患者的临床资料,按降调节方案分为4组:A组174例,隔日注射短效GnRHa 0.1 mg降调节;B组77例,每日注射短效GnRHa 0.1 mg降调节;C组323例,一次性注射长效GnRHa 0.75 mg降调节;D组285例:一次性注射长效GnRHa 0.93 mg降调节。比较4组患者卵泡发育情况和妊娠结局。【结果】降调节14 d后,A组的血FSH(4.51±1.61)IU/L、LH(2.64±1.45)IU/L,显著高于其它三组(4.04±1.21、2.27±1.55;2.79±1.44、2.13±1.03;2.69±1.26、2.02±0.96)IU/L差异有统计学意义(P<0.05)。A组、B组、C组和D组HCG日直径大于14 mm的卵泡数分别为:7.95±3.49、9.18±4.09、9.6±4.17和10.43±4.41,占总卵泡的比例为:A组55.43%、B组66.62%、C组59.67%、D组66.73%,其中A组较其它三组低,差异有统计学意义(P<0.05)。A组Gn使用时间(d)长(9.78±1.51;10.81±1.93;11.16±1.98;11.4±2.12),获卵数(10.38±4.68;12.17±5.29;12.97±5.29;13.59±5.41)、MⅡ卵子数(8.91±4.1;10.25±4.58;11.36±4.92;11.95±5.02)和利用胚胎数(5.7±3.05;5.97±3.47;7.35±4.12;7.89±4.0)在A组中均较少(P<0.05)。A组临床妊娠率和种植率为49.42%、32.99%,低于其它3组(55.84%、39.39%;57.59%、37.82%;60%、41.22%),差异有统计学意义(P<0.05)。【结论】隔天注射短效GnRHa降调节不能有效控制促排卵过程中的LH水平,不利于卵泡早期的同步募集,影响卵泡发育同步化及IVF成功率。[ Objective ] To compare the effect of different GnRHa down-regulation long protocols on the synchronization of follicular development and IVF outcomes. [ Methods ] A total of 859 cycles of long protocol IVF/ICSI were analyzed retrospectively and divided into four groups： Group A （174 cycles） ： patients received short-acting GnRHa 0.1 mg every other day starting from day 20 of the previous cycle, after 14 days the dosage was changed to 0.1 mg/day and continued until the day HCG was administered. Group B （77 cycles） ：patients received short-acting GnRHa0. 1 mg/d starting from day 20 of the previous cycle till the day HCG was administered; Group C （323 cycles） ： patients received a single depot injection of GnRHa 0.75 mg on day 20 of the previous cycle; Group D （285 cycles） ： patients received a single depot injection of GnRHa 0.93 mg on day 20 of the previous cycle. Serum FSH and LH levels on day 1 of gonadotropin stimulation, the number of 〉14 mm follicles on HCG day and the number of oocytes retrieved, high quality embryos rate, clinical pregnancy rate and implantation rate were compared respectively. [ Results ] After down-regulation for 14days,serum FSH （4.51 ± 1.61） IU/L and LH levels （2.64 ± 1.45） IU/L were much higher in group A than in other groups （4.04 ± 1.21, 2.27 ± 1.55; 2.79 ± 1.44, 2.13 ± 1.03; 2.69 ± 1.26, 2.02 ± 0.96） IU/L, the differences were statistically significant （P〈 0.05）. On the day of HCG was administered, there were more 〉 14 mm follicles in group A （7.95 ± 3.49, 55.43%） than others （9.18 ± 4.09, 66.62%; 9.6 ± 4.17, 59.67%; 10.43 ± 4.41, 66.73%）. Patients in group A required more days of gonadotropin stimulation （9.78 ± 1.51; 10.81 ± 1.93; 11.16 ± 1.98; 11.4 ± 2.12） days, but with less oocytes retrieved （10.38 ± 4.68; 12.17 ± 5.29; 12.97 ± 5.29; 13.59 ± 5.41）, mature ooeytes （8.91 ± 4.1; 10.25 ± 4.58; 11.36 ± 4.92; 11.95 ± 5.02） and embryos available （5.7 ± 3.05; 5.97 ± 3.47; 7.35 ± 4.12; 7.8

关 键 词：GNRHA 降调节 卵泡发育同步化 

分 类 号：R711.5[医药卫生—妇产科学]