促性腺激素释放激素激动剂不同降调节方案对子宫内膜异位症患者IVF结局的研究  

Effect of different kinds of GnRH agonist down regulation protocols on clinical outcome of IVF in women with endometriosis

作　　者：张群芳[1] 陈国勇[1] 刘芸[1] 宋岩峰[1] 

机构地区：[1]南京军区福州总医院妇产科生殖中心,福州350025

出　　处：《生殖医学杂志》2015年第9期732-736,共5页Journal of Reproductive Medicine

基　　金：南京军区医学科技面上项目(2013MS125);福州总医院科研课题(201212)

摘　　要：目的探讨短方案、长方案以及超长方案降调节对子宫内膜异位症(EMs)不孕患者体外受精-胚胎移植(IVF-ET)助孕治疗结局的影响。方法回顾性分析2011年1月至2012年12月间共165例EMs患者IVF新鲜移植周期,按降调节方案分为:A组(短方案)、B组(长方案)、C组(超长方案),比较3种降调节方案对IVF-ET妊娠结局的影响。结果与A、B组比较,C组基础睾酮(T)显著升高(P<0.01),促性腺激素(Gn)时间明显延长(P<0.05);C组Gn用量、HCG注射日雌二醇(E2)水平、子宫内膜厚度、移植胚胎数、受精率、卵裂率、流产率、异位妊娠率、重度卵巢过度刺激综合征(OHSS)发生率和因E2过高取消移植率,与A、B组比较均无显著性差异(P>0.05)。B组获卵率较于A组和C组有增高趋势[(77.53±18.83)%vs.(71.72±17.30)%、(68.50±19.52)%],但差异无统计学意义(P>0.05)。C组、B组、A组临床妊娠率、优胚率和种植率有升高趋势,分别为[47.36%(9/19)vs.44.05%(37/84)vs.41.18%(7/17)]、[(75.47±33.34)%vs.(72.63±35.37)%vs.(72.62±30.81)%]和[33.33%(12/36))vs.29.81%(48/161)vs.28.13%(9/32)],但差异亦无统计学意义(P>0.05)。结论短方案、长方案和超长方案降调节都是IVF-ET治疗EMs不孕患者的有效手段。长方案组获卵率有增高趋势。超长方案Gn时间增加,但临床妊娠率、优胚率和种植率相比短方案和长方案有升高趋势。Objective： To explore the clinical outcome of different pituitary down regulation protocols with GnRH agonist in patients with endometriosis undergone IVF-ET. Methods： The clinical and laboratory data of 165 patients with endometriosis in our center from January 2011 to December 2012 were retrospectively analyzed. The patients were applied with short protocol（group A, n = 21 ）, long protocol （ group B, n = 119 ） and prolonged protocol （ group C, n = 25 ） respectively. Results： The basal serum testosterone（T）levels in group C were significantly higher than those in group A and B（P〈0. 01）. The duration of gonadotropin used in group C was significantly higher than that in group A and B（P〈0.05）. There were no significant difference in gonadotropin dosage used,E2 levels and endometrial thickness on HCG injection day, number of embryo transfer, fertilization rate, cleavage was no significant difference （P〈0. 05）. The clinical pregnancy rate, good-quality embryos rate and implantation rate in the group C were higher than those of the group A, but there were no significant difference（P〉0.05）. Conclusions： The short, long and prolonged down-regulation protocols are all effective for the patients with endometriosis undergoing IVF-ET. The oocyte recovery rate has increasing tendency in the long protocol. The gonadotropin duration used is significantly higher,and the rates of clinical pregnancy,good- quality embryo and implantation in the prolonged protocol have increasing tendency compared with the short and long protocols.

关 键 词：子宫内膜异位症 体外受精-胚胎移植 促性腺激素释放激素激动剂 

分 类 号：R4[医药卫生—临床医学]