GnRH激动剂长方案与GnRH拮抗剂方案在不同年龄组、不同反应人群中的新鲜周期临床结局比较  

Comparison of the Clinical Outcomes of Fresh Embryo Transfer with GnRH Agonist Long Protocol Versus Gn RH Antagonist Protocol in Different Age Groups and Different Responders

作　　者：朱洁茹[1] 欧建平[1] 邢卫杰[1] 陶欣[1] 蔡柳洪[1] 李涛[1] 孙丽 林慧[1] ZHU Jie-ru OU Jian-ping XING Wei-jie TAO Xin CAI Liu-hong LI Tao SUN Li LIN Hui(Center for Reproductive Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院生殖医学中心,广东广州510630

出　　处：《中山大学学报（医学科学版）》2017年第5期738-745,共8页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】比较促性腺激素释放激素激动剂(GnRH-a)长方案和促性腺激素释放激素拮抗剂(GnRH-ant)方案在不同年龄组和不同反应人群中行体外受精或单精子卵胞浆内注射-胚胎移植(IVF/ICSI-ET)新鲜周期移植的临床结局。【方法】回顾性分析中山大学附属第三医院生殖医学中心2015年8月28日至2016年12月31日行IVF/ICSI的737个周期,其中Gn RH-a长方案(A组)386个周期,GnRH-ant方案(B组)351个周期。按年龄和获卵数分成a和b两个亚组:a1组(<38岁),a2组(≥38岁);b1组(获卵数≤5个),b2组(获卵数6~15个),b3组(获卵数>15个)。比较患者的临床资料和助孕结局。【结果】(1)A、B两组的受精率、正常受精率、生化妊娠率、流产率均无统计学差异,A组的促性腺激素(Gn)使用天数、Gn总量、人绒毛膜促性腺激素(hCG)日雌二醇(E2)浓度、h CG日内膜厚度、获卵数、成熟卵子数、卵巢过度刺激综合征(OHSS)发生率、胚胎种植率、临床妊娠率均高于B组(P<0.05),B组的新鲜周期移植取消率高于A组(P<0.001)。(2)按年龄分层后,<38岁亚组使用Gn RH-ant方案的胚胎种植率略低于Gn RH-a长方案(32.6%vs 39.8%,P=0.067),两种方案的临床妊娠率没有统计学差异(54.8%vs 50.4%,P=0.429);≥38岁亚组使用Gn RH-ant方案的胚胎种植率低于Gn RH-a长方案(9.7%vs17.9%,P=0.066),使用Gn RH-ant方案的临床妊娠率低于Gn RH-a长方案(19.6%vs 39.1%),差异有统计学意义(P=0.021)。(3)按获卵数分层后,除b1亚组Gn RH-ant方案的胚胎种植率低于Gn RH-a长方案以外(13.1%vs 26.0%,P=0.026),b2、b3亚组使用两种方案的胚胎种植率没有统计学差异;b1、b2、b3三个亚组使用两种方案的临床妊娠率均没有统计学差异,但是b1亚组两种方案的临床妊娠率相差较大(36.6%vs 19.3%,P=0.056)。【结论】总体而言,Gn RH-a长方案的胚胎种植率和临床妊娠率高于Gn RH-ant方案,但Gn RH-ant方案可降低Gn的用量,缩短治疗时间,并有效减少OHS【Objective】To compare the clinical outcomes of fresh embryo transfer of the in vitro fertilization/intracytoplasmic sperm injection and embryo transfer（IVF/ICSI-ET）in different age groups as well as in different responders using gonadotropin-releasing hormone agonist（Gn RH-a）long protocol or Gn RH antagonist（Gn RH-ant）protocol.【Methods】A retrospective analysis was performed on 737 IVF/ICSI cycles,including 386 cycles of Gn RH-a long protocol（group A）and 351 cycles of Gn RH-ant protocol（group B）,from August 28,2015 to December 31,2016. Then all the cycles were divided into sub-groups by ages and retrieved oocyte numbers：group a1（ 38 years）,group a2（≥ 38 years）;group b1（n ≤ 5）,group b2（6 ≤ n ≤ 15）,group b3（n 15）. Thebasic information of patients and clinical outcomes were compared.【Results】（1）Comparable results were obtained from group A and group B in these following variables such as fertilization rate,normal fertilization rate,biochemical pregnancy rate and miscarriage rage. But the stimulation period,the total gonadotropin（Gn）dosage,estradiol（E2）level and endometrial thickness on the day of human chorionic gonadotropin（h CG）administration,number of oocytes retrieved and mature oocytes,ovarian hyperstimulation syndrome（OHSS）rate,implantation rate and clinical pregnancy rate were significantly higher in group A than group B（P〈0.05）,and significantly higher cancellation rate of fresh embryo transfer was observed in group B（P〈0.001）.（2）When divided by ages,no matter in sub-group a1 or sub-group a2,the implantation rate was slightly lower in Gn RH-ant protocol than in Gn RH-a long protocol,although they failed to reach significant difference（sub-group a1：32.6% vs 39.8%,P = 0.067;sub-group a2：9.7% vs 17.9%,P =0.066）. The clinical pregnancy rate was comparable using these two protocols in sub-group a1（54.8% vs 50.4%,P = 0.429）,but it was significantly lower by using Gn RH-ant protocol than Gn RH-a long protoco

关 键 词：促性腺激素释放激素激动剂 促性腺激素释放激素拮抗剂 体外受精-胚胎移植 辅助生殖技术 

分 类 号：R711.6[医药卫生—妇产科学]