不同GnRH-a制剂的长方案中卵巢刺激后E_2水平的动态变化  

Dynamics of estradiol production in different GnRH agonist down regulation long protocols

作　　者：高军[1] 苗本郁[1] 刘新颜[1] 王轶子[1] 周灿权[1] 徐艳文[1] 

机构地区：[1]中山大学附属第一医院生殖医学中心广东省生殖医学重点实验室,广州510080

出　　处：《生殖医学杂志》2015年第10期824-828,共5页Journal of Reproductive Medicine

基　　金：广东省生殖医学重点实验室项目(2012A061400003);广东省科技计划项目(2008A030201028);公益性行业专项基金(201402004)

摘　　要：目的对比分析短效和长效GnRH-a制剂的长方案中卵巢刺激后E2水平的动态变化,为临床促排卵过程中药物剂量的调整提供依据。方法回顾性分析2014年1月1日~2014年9月30日在本院生殖医学中心使用GnRH-a长方案的IVF/ICSI/胚胎植入前遗传学诊断（PGD）理想周期资料。纳入标准：年龄≤35岁,促排卵过程中没有进行促性腺激素剂量（Gn）的调整,获卵数在11~15个,促排天数在9~13d。按照降调节制剂剂型的不同,将纳入研究的88个周期分为短效长方案组（A组,共34个周期）和减量长效长方案组（B组,共54个周期）,对比分析两组在启动日、促排第5天、第8天以及HCG日E2水平的变化。结果 A组总促排卵天数显著短于B组[（10.2±1.4）vs.（11.3±1.1）d],Gn使用总剂量也显著低于B组[（1 766.8±524.6）vs.（2 134.9±603.6）U]（P〈0.05）。A组促排第5天E2水平[（1 236.0±646.7）vs.（739.0±482.4）pmol/L]及促排第8天E2水平[（5 043.1±2 611.4）vs.（3 885.1±2 345.7）pmol/L]均显著高于B组（P〈0.05）,HCG日两组E2水平无显著差异,平均每个卵的E2水平无显著差异（P〉0.05）。A组和B组的临床妊娠率分别为68.2%和71.8%,胚胎植入率分别为40.4%和48.8%,差异均无统计学意义（P〉0.05）。结论长方案中GnRH-a制剂的类型影响卵巢刺激后E2水平的动态变化。Objective：To compare dynamic estradiol production between short-acting and long-acting GnRH agonist（GnRH-a）long protocols,for the adjustment of gonadotropin dosage during ovarian stimulation.Methods：The data of 88IVF/ICSI/PGD cycles in our center from Jan 2014 to Sep 2014 were analyzed retrospectively.The inclusion criteria included the followings：age≤35years old,no gonadotropin（Gn）adjustment during stimulation,number of oocytes from 11 to 15,Gn days from 9to 13.According to different down regulation protocols,88 cycles were divided into two groups：group A with short-acting GnRH-a（n=34）,and group B with long-acting GnRH-a（n=54）.Estradiol levels on starting day,stimulation day 5and 8,HCG day were analyzed.Results：Group A had significantly shorter duration of ovarian stimulation [（10.2±1.4）vs.（11.3±1.1）days]and lower total gonadotropin dosage[（1 766.8±524.6）vs.（2 134.9±603.6）U ]than group B（P〈0.05）.The estradiol levels on day 5 [（1 236.0±646.7）vs.（739.0±482.4）pmol/L]and day8 [（5 043.1±2 611.4）vs.（3 885.1±2 345.7）pmol/L ]of group A were significantly higher than group B（P〈0.05）.No significant difference in estradiol levels on HCG day was found between group A and B（P〉0.05）.There also were no significant differences in clinical pregnancy rates（68.2% vs.71.8%）and implantation rates（40.4% vs.48.8%）between the two groups（P〉0.05）.Conclusions：GnRH-apreparation in long protocol has impacts on the dynamics of estradiol production after ovarian stimulation.

关 键 词：促性腺激素释放激素激动剂 长方案 体外受精-胚胎移植 

分 类 号：R[医药卫生]