长、短效促性腺激素释放激素激动剂在体外受精-胚胎移植中自身对照研究  

Self-control comparison of long and short-acting GnRH-agonist in IVF-ET

作　　者：高军[1] 苗本郁[1] 欧建平[1] 徐艳文[1] 周灿权[1] 

机构地区：[1]中山大学附属第一医院生殖医学中心,广东广州510080

出　　处：《生殖医学杂志》2013年第10期744-748,共5页Journal of Reproductive Medicine

基　　金：广东省医学科研基金资助项目(B2012091)

摘　　要：目的比较促性腺激素释放激素激动剂(GnRH-a)减量长效长方案和短效长方案在体外受精-胚胎移植(IVF-ET)中的应用。方法 2011年1月至2012年5月在本院生殖中心进行重复长方案,第一周期长效长方案第二周期短效长方案者共64人,第一周期短效长方案第二周期长效长方案者共79人。回顾性分析143名患者的286个周期资料进行自身对照研究,按照方案分为长效长方案组(组A)和短效长方案组(组B)。结果患者平均年龄(32.0±4.0)岁,平均不育年限(4.7±3.2)年。两组启动剂量无显著差异,组B启动日卵泡刺激素(FSH)和雌二醇(E_2)水平均显著高于A组。组B促排卵时间明显缩短[(9.9±1.5)vs(11.8±1.6)天],促性腺激素(Gn)使用剂量明显减少[(2,093.2±615.7)Vs(2,610.8±770.2)IU]。人绒毛膜促性腺激素(HCG)日组B的E_2水平显著高于组A[(10,702.94±4,582.32)vs(9,621.04±4,330.15)pmol/L],孕酮(P)水平显著低于组A[(1.90±0.95)vs(2.54±1.27)nmol/L],差异均有统计学意义(P<0.05)。两组获卵数,正常受精率、移植胚胎数目及可用胚胎数目均无统计学差异。组A的卵胞浆内单精子注射(ICSI)周期成熟卵母细胞率显著高于组B[(82.2±18.7)vs(74.7±20.3)%]。每组均选取第二周期进行临床妊娠率和植入率的比较,组A和组B的临床妊娠率分别为42.3%和48.3%,胚胎植入率分别为22.3%和26.2%,差异均无统计学意义。两组自然流产率无统计学差异。结论单次注射的减量长效长方案可以获得与多次注射的短效长方案相似的妊娠结局。长效降调节对垂体的抑制程度更深,在促排卵过程中用药量更大,用药时间更长。Objective： To compare the effect of long and short-acting gonadotropin-releasing hormone agonist （GnRH-a） on pituitary down-regulation and clinical outcome of in vitro fertilization and embryo transfer cycles. Methods： Sixty four patients received long-acting GnRH-a for the first cycle and short-acting GnRH-a for the second cycle, and 79 patients received short-acting GnRH-a for the first cycle and long-acting GnRH-a for the second cycle in our hospital from Jan. 2011 to May 2012 were recruited in this study. Group A consisted of cycles with long-acting GnRH-a down regulation, while group B consisted of cycles with short-acting GnRH-a down regulation. Results： Mean age was （32.0 ± 4.0） years. Duration of infertility was （4.7±3.2） years. The serum FSH and E2 levels on the day of gonadotropin （Gn） initiation were significantly higher in group B compared with group A. Both Gn stimulation days and Gn doses were significantly higher in group A [（9.9±1.5） days vs. （11.8±1.6） days, （2,093.2±615.7） IU vs. （2,610.8±770.2） IU,P〈 0.05]. On the day of HCG injection,the serum E2 level was significantly higher in group B[（10,702.9±4,582.32） vs. （9,621.04 ± 4,330.15） pmol/L], P〈 0. 051, while the progesterone level was significantly lower [（1.90±0.95） vs. （2.54 ± 1.27） nmol/L]. There were no significant differences with regards to the number of retrieved oocytes, fertilization rate, number of transferred embryos and embryo utilization rate. The oocyte maturation rate was significantly higher in group A compared with group BE（82.2± 18.7）% vs. （74.7 ±20.3）%, P 〈 0.05]. The clinical pregnancy rate, implantation rate, and early pregnancy loss rate were not significantly different in the last treatment cycles between the two groups. Conclusions： Both long and short-acting GnRH-a protocol can be successfully used in IVF-ET. Deeper down regulation will be achieved in the long-acting GnRH-a protocol, which may result in higher Gn dosage and longer stim

关 键 词：促性腺激素释放激素激动剂 体外受精-胚胎移植 垂体降调节 

分 类 号：R[医药卫生]