在GnRH拮抗剂方案中添加来曲唑对卵巢储备功能低下者体外受精-胚胎移植结局的影响  

The Effect of Addition of Letrozole to GnRH Antagonist Regimens on In Vitro Fertilization and Embryo Transfer Outcome in Patients with Low Ovarian Reserve

作　　者：左振伟 乔杰[1] 李红真[1] 

机构地区：[1]北京大学第三医院,北京100191 [2]河北联合大学附属医院,河北唐山063000

出　　处：《实用妇产科杂志》2013年第5期351-354,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨在促性腺激素释放激素(GnRH)拮抗剂方案中添加来曲唑(LZ),对卵巢储备功能低下者体外受精-胚胎移植(IVF-ET)结局的影响。方法:回顾性分析63个应用LZ结合小剂量促性腺激素(Gn)的IVF周期(Gn+LZ组)和177个单纯应用大剂量Gn的IVF周期(Gn组)的临床结局。Gn+LZ组在月经周期第2～6天给予LZ5mg/d,于月经周期第5天开始加用Gn150～225U/d。Gn组在月经周期第2天开始应用Gn300～450U/d。两组均在月经周期的第7天开始给予醋酸西曲瑞克(思则凯)0.25mg/d,直至HCG日。结果:Gn+LZ组的周期取消率显著高于Gn组(P=0.005),获卵数显著低于Gn组(P=0.000),但着床率显著高于Gn组(P=0.006)。两组的妊娠率、临床妊娠率和继续妊娠率差异无统计学意义(P>0.05)。Gn+LZ组的Gn用量显著低于Gn组(P=0.000)。结论:卵巢储备功能低下者在拮抗剂方案中添加LZ可以改善着床率,妊娠结局与应用单纯大剂量Gn相似,同时减少了患者Gn的用量。Objective：To evaluate the effect of addition of letrozole in GnRH antagonist regimens on in vitro fertilization and embryo transfer（IVF-ET） outcome in patients with low ovarian reserve. Methods：It was a retrospective analysis. Letrozole （LZ）combined with low-dose gonadotropin （Gn）was used in 63 IVF cycles. High-d0se Gn alone was used in 177 IVF cycles. In Gn ＋ LZ group, letrozole 5 mg/d was given from day 2 of the menstrual cycle for five days. Gonadotropin 150 -225 U/d was started from the fifth day of the cycle. In the Gn-alone group, gonadotropin 300 -450 U/d was started from the second day of the cycle. Cetrotide 0. 25 mg/d was prescribed from the seventh day of the cycle until the day of HCG administration in both groups. Results：The rate of cycle cancellation was significantly higher in Gn ＋ LZ group than in Gn-only group（ P = 0. 005 ）. The number of oocytes retrieved in the Gn ＋ LZ group was significantly lower than Gn-only group（. P =0. 0007. However ,the implantation rate was much higher in Gn ＋ LZ group than in Gn-onf ly group（ P=-0. 006）. The pregnancy rate,the clinical pregnancy rate and the ongoing pregnancy rate were similar between two groups（P〉0.05）. The amount of total Gn dose used was much lower in Gn ＋ LZ group than in Gn-only group（ P =0. 000）. Conclusions.Addition of letrozole in GnRH antagonist regimens in patients with poor ovarian reserve can improve the implantation rate and obtain similar outcome with those with high dose of Gn protocol,and reduce the Gn dose for IVF treatment.

关 键 词：来曲唑 体外受精-胚胎移植 卵巢储备功能低下 GNRH拮抗剂 

分 类 号：R711.6[医药卫生—妇产科学]