不同年龄段患者促性腺激素释放激素拮抗剂方案与激动剂长方案助孕结局比较  

Comparisons of GnRH antagonist verse GnRH agonist protocol in patients of different age groups devided by 38 years old

作　　者：谭雯雅[1] 陈雷宁[1] 欧湘红[1] 李红[1] 罗琛[1] 陈思梅[1] 全松[1] 

机构地区：[1]南方医科大学南方医院妇产科生殖医学中心,广东广州510515

出　　处：《中国实用妇科与产科杂志》2013年第6期438-442,共5页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨不同年龄段患者促性腺激素释放激素拮抗剂(GnRH-ant)方案与促性腺激素释放激素激动剂(GnRH-a)长方案体外受精/单精子卵胞浆内注射-新鲜胚胎移植(IVF/ICSI-ET)周期及冷冻胚胎移植(FET)周期妊娠结局。方法回顾性分析南方医科大学南方医院生殖医学中心2010年4月1日至12月31日GnRH-ant方案组(A组)259个周期、同期黄体中期GnRH-a长方案组(B组)318个周期,并以38岁为界分为亚组A1(<38岁)、A2(≥38岁)和B1(<38岁)、B2(≥38岁)。在A1与B1组及A2与B2组中,比较A组与B组临床资料及妊娠结局。结果 A1组新鲜胚胎移植周期的促性腺激素(Gn)用量较B1组少,胚胎种植率及临床妊娠率均较B1组低;A1组卵巢过度刺激综合征(OHSS)发生率低于B2组,差异有统计学意义;两组活胎分娩率、流产率及早产率差异无统计学意义。A组与B组冷冻胚胎移植周期分年龄段比较,治疗结局差异均无统计学意义。A1组冷冻胚胎移植周期临床妊娠率明显高于新鲜移植。A2组新鲜移植与冷冻移植各项治疗结局差异无统计学意义。结论对<38岁患者,GnRH-ant方案虽然可减少Gn用药量以及降低OHSS发生率,但临床妊娠率比经典长方案低。在高龄患者中,拮抗剂方案也无明显优势。冷冻胚胎移植可改善临床妊娠率。拮抗剂或长方案的选择使用不影响妊娠后的远期结局。Objective To analyze the outcomes of GnRH antagonist protocols in IVF/ICSI-ET cycle and frozen-thawed embryo transter（FET） cycle in two age groups divided by the 38- years- old. Methods A retrospective analysis was performed on 259 patients received GnRH-ant protocols（ Group A） comparing to 318 patients with GnRH agonist regimens （Group B） , and divided into Sub-group A1 and A2 ,B1 and B2 by the age of 38 years. Comparison about patients basic information and treatment outcomes including the number of oocytes retrieved, embryo implantation rate,clinical pregnancy rate , abortion rate , preterm labor rate,live-birlh rate as well as cycle eanceling rate was made between Group A and Group B in two diferent age groups. Results In the fresh cycle, embryo implantation rate and clinical pregnancy rate in Group A1 was significantly lower than that in Group B1 , although Group A1 consumed less Gn amount. However, the incidence of OHSS marked decreased in Group A . No statistically difference was observed in live-birth rate , abortion rate and preterm labor rate. In FET cycle, GnRH antagonist protocols were shown to be at least as effective as long GnRH ag- onist regimens. Furthermore, in the GnRH antagonist group,fi＇esh embryo transfer conducting on patients less than 38 years old resulted in lower clinical pregnancy rate but similar live-birth rate compared with frozen-thawed embryo transfer. While in patients older than 38 years, fresh embryo transfer and frozen-thawed embryo transfer displayed a similar treatment effect. Conclusion Although GnRH antagonist protocol results in reduced treatment burden （duration and side effects） and less risk of ovarian stimulation syndrome, it is associated with lower clinical pregnancy rate in normal responders. GnRH antagonist is not recommended as the routine choice for the advanced age patients. Frozen-thawed era-bryo transfer can improve the clinical pregnancy rate. The type of analogue seems to have no influence on pregnancy outcomes.

关 键 词：促性腺激素释放激素拮抗剂 体外受精/单精子卵胞浆内注射-新鲜胚胎移植 冷冻胚胎移植 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]