促性腺激素释放激素激动剂联合低剂量人绒毛膜促性腺激素扳机在高反应患者体外受精治疗中的应用  

Application of gonadotropin-releasing hormone agonist combined with low dose human chorionic gonadotropin trigger in the in vitro fertilization of high responder

作　　者：杨硕[1] 何艺磊[1] 梁靓[1] 李蓉[1] 陈新娜[1] 甄秀梅[1] 王丽娜[1] 王海燕[1] 马彩虹[1] 刘平[1] 乔杰[1] Yang Shuo;He Yilei;Liang Liang;Li Rong;Chen Xinna;Zhen Xiumei;Wang Lina;Wang Haiyan;Ma Caihong;Liu Ping;Qiao Jie(Obstertrics ＆ Gynecology Department, Reproductive Medical Science Center, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院妇产科生殖医学中心,100191

出　　处：《中华生殖与避孕杂志》2018年第3期181-185,共5页Chinese Journal of Reproduction and Contraception

摘　　要：目的探索低剂量人绒毛膜促性腺激素(h CG)双扳机在高反应患者中应用的安全性及有效性。方法回顾性分析2014年1月1日—2015年12月31日期间采取促性腺激素释放激素(GnRH)拮抗剂方案进行控制性促排卵行体外受精/卵胞质内单精子显微注射(IVF/ICSI)助孕的患者,因卵巢高反应采用低剂量h CG扳机的患者(A组,n=431),同期采用标准hCG扳机的患者,以年龄和获卵数1∶2配对(B组,n=862)进行队列研究。比较分析患者的一般资料及治疗结局。结果患者年龄等一般情况差异无统计学意义,两组患者促性腺激素(Gn)启动剂量及用药时间比较等差异无统计学意义(P>0.05)。A组患者hCG扳机日血清雌二醇(E_2)水平[(16 261±6 561)pmol/L]显著高于B组患者[(12 795±6 133)pmol/L](P=0.000)。ICSI受精率、MII卵比率组间比较差异均无统计学意义(P>0.05),A组患者双原核(2PN)率(56.0%)显著高于B组(54.7%)(P=0.001)。临床妊娠率、胚胎着床率、早期流产率及活产率组间比较差异均无统计学意义(P>0.05)。A组有5例患者发生重度卵巢过度刺激综合征(OHSS)。结论使用拮抗剂方案的高反应患者,使用减量联合扳机,得到满意临床结局的同时,不增加OHSS发生率,新鲜周期也得到了满意的治疗结局。Objective To investigate the effectiveness and safety of low dose human chorionic gonadotropin （hCG） dual trigger, by comparing the in vitro fertilization/intracytoplasmic sperm injection （IVF/ ICSI） outcomes of high responders using low dose hCG dual trigger or standard hCG trigger. Methods This was a retrospective cohort study. The patients accepted IVF/ICSI treatment in Reproductive Medical Center of Peking University, between Jan. 1st 2014 and Dec. 31st 2015, with gonadotropin-releasing hormone antagonist （GnRH-A） flexible protocol. The research group was high responders using low dose hCG dual trigger （group A, n=431）, paired by age and number of oocytes retrieved （1 ： 2）, over the same period （group B, n=862）. The general characteristics and treatment outcomes were compared between the two groups. Results There were no significant differences between the two groups refer to general characteristics, and gonadotropin （Gn） used dosage （P〉0.05）. The serum E： level on hCG trigger day in group A [（16 261±6 561 pmol/L] was significantly higher than that in group B [（12 795±6 133）pmol/L, P=0.000]. The fertilization rate of ICSI and MH oocyte rate were comparable between two groups （P〉0.05）. The rate of two pronucleus （2PN） oocytes was significantly higher in group A （56.0%） than that in group B （54.7%） （P=0.001）. The clinical pregnancy rate, the implantation rate, the miscarriage rate and live birth rate were comparable between two groups （P〉0.05）. There were 5 patients in group A who suffered severe ovarian hyperstimulation syndrome （OHSS）. Conclusion For high responders, besides of GnRH antagonist protocol, using low dose hCG dual trigger, will get satisfied clinical outcomes and do not increase the incidence of OHSS, and get satisfied clinical outcomes in fresh cycle.

关 键 词：GnRH拮抗剂(GnRH-A) 高反应 控制性卵巢刺激(COS) GnRH激动剂(GnRHa)扳机 联合扳机 

分 类 号：R714.8[医药卫生—妇产科学]