拮抗剂方案中应用促性腺激素释放激素激动剂诱发卵母细胞成熟后不同黄体支持方案对妊娠结局的影响——一项提前终止的前瞻随机临床对照研究  

Different supplement regiments for luteal support after GnRH agonist triggering in GnRH antagonist protocol-a prospective randomized controlled trial(RCT)

作　　者：刁飞扬 王嫜 黄洁 吴畏 吴春香 侯振 刘金勇 孟艳 冒韵东 舒黎 马翔 刘嘉茵 

机构地区：[1]南京医科大学第一附属医院临床生殖中心,生殖医学国家重点实验室,南京210029

出　　处：《生殖医学杂志》2013年第10期797-801,共5页Journal of Reproductive Medicine

摘　　要：目的 (1)在促性腺激素释放激素拮抗剂(GnRH-ant)方案中应用促性腺激素释放激素激动剂(GnRH-a)诱发卵母细胞最终成熟后,在黄体支持方案中比较孕激素+人绒毛膜促性腺激素(HCG)和孕激素+雌激素两种不同的黄体支持方案对妊娠结局的影响;(2)在GnRH-ant方案中比较添加高纯度人绝经期促性腺激素(HP-HMG)和添加人重组黄体生成素(rLH)对妊娠结局的影响。方法前瞻随机对照的临床实验。对照组32例,添加rLH,GnRH-a诱发卵母细胞最终成熟后12 h添加1,000 IU、35 h添加500 IU HCG,取卵后应用孕激素;实验Ⅰ组37例,添加HP-HMG,黄体支持方案同对照组;实验Ⅱ组33例,添加HP-HMG,取卵后应用孕激素和雌激素。结果对照组、实验Ⅰ组和实验Ⅱ组的新鲜周期胚胎移植周期临床妊娠率分别是38.10%、23.08%和8.70%,实验Ⅱ组新鲜周期临床妊娠率明显低于本中心质控标准,该临床实验提前终止。对照组、实验Ⅰ组和实验Ⅱ组未妊娠者已有33例进行了冷冻胚胎移植周期,其临床妊娠率分别为50.00%,63.64%和57.14%。三组均无中重度卵巢过度刺激综合征(OHSS)发生。结论拮抗剂方案中应用GnRH-a诱发卵母细胞成熟可以避免中重度OHSS的发生,且不影响胚胎质量。GnRH激动剂诱发卵母细胞成熟对黄体功能和内膜容受性存在不利影响,单纯补充雌孕激素无法替代HCG的作用。Objective： 1. To study the different effects on pregnancy outcome in GnRH antagonist protocol by using highly purified human menopausal gonadotropin （HP-HMG） or recombinant LH （r-LH）;2. To investigate the effect on the pregnancy outcome by using different supplement regiments for luteal support such as progesterone plus estrogen or progesterone plus HCG after GnRH agonist triggering. Methods： A prospective randomized controlled trial （RCT） was performed in 2012. The r-LH was added and luteal support was by supplementing progesterone and HCG in control group, HP-HMG and progesterone ＆ HCG in Test I group,and HP-HMG and progesterone ＆ estrogen in Test II group. Results： In the three groups,clinical pregnancy rates were 38.10% ,23.08% ,8.70% in fresh embryo cycle,and 50.00% ,63.64% ,57.14% in frozen embryo cycle respectively. Because the outcomes of Test II group were dramatically lower than quality control in our center,the RCT was stopped ahead of schedule. No moderate or serious ovarian hyperstimulation syndrome （OHSS） occurred in the three groups. Conclusions： Periodic results revealed that GnRH agonist triggering in GnRH antagonist protocol can avoid moderate or serious OHSS without influencing embryo quality. Supplement of progesterone plus estrogen can not replace the role of HCG after GnRH agonist triggering due to impaired endometrial receptivity.

关 键 词：GNRH拮抗剂 GnRH激动剂诱发排卵 卵巢过度刺激综合征 黄体支持 冻胚移植 口服避孕药 

分 类 号：R[医药卫生]