早卵泡期亮丙瑞林降调节在PCOS患者行体外受精-胚胎移植中的应用探讨  

Application of leuprorelin in the early follicular phase of the infertile patients with PCOS in IVF/ICSI-ET

作　　者：李游[1] 易迎春[1] 万蓉[1] 黄志辉[1] 伍琼芳[1] LI You;YI Yingchun;WAN Rong;HUANG Zhihui;WU Qiongfang(Center for Reproductive Medicine,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China.)

机构地区：[1]江西省妇幼保健院辅助生殖中心,南昌330006

出　　处：《江西医药》2018年第3期202-204,211,共4页Jiangxi Medical Journal

基　　金：江西省卫生计生委科技项目;编号20155543

摘　　要：目的探讨早卵泡期亮丙瑞林降调节与黄体中期达必佳长方案降调节在多囊卵巢综合征(PCOS)不孕症患者行体外受精-胚胎移植(IVF-ET)治疗的运用。方法纳入了本院2015年1月到2015年12月间来院首次行IVF-ET或卵胞质内单精子注射术(ICSI)的PCOS患者为研究对象,进行随机分组,100例进行早卵泡期亮丙瑞林降调节(A组),100例进行黄体中期常规达必佳长方案降调节(B组)。常规促排卵及胚胎培养移植。比较两组间临床和结局相关指标。结果⑴两组的年龄20-35岁,平均年龄、平均不孕年限、体重指数(BMI)均无统计学差异。两组血基础促黄体生成素(LH)、促卵泡生成素(FSH)、雄激素(TT)、抗苗勒氏管激素(AMH)均无统计学差异。⑵IVF治疗中相关指标比较,A组HCG日LH值0.95m IU/ml明显低于B组1.46m IU/ml;A组HCG日E2值2896pg/ml明显低于B组3764pg/ml;A组2PN受精率50.16%低于B组54.01%,差异均有统计学意义。两组Gn总量、Gn天数、HCG日内膜厚度、HCG日孕酮(progesterone,P)值、获卵数、2PN卵裂率、全胚冷冻率和OHSS发生率,差异均无统计学意义。⑶两组移植后比较,A组临床妊娠率88.06%明显高于B组的63.49%;A组种植率63.38%明显高于B组的52.63%;A组活产率83.58%明显高于B组的55.56%,差异均有统计学意义。两组移植胚胎数、多胎率、流产率差异无统计学意义。结论在PCOS患者行IVF-ET治疗中,早卵泡期亮丙瑞林降调节与常规长方案相比,能够更好地控制促排卵过程中LH的分泌,降低HCG日LH和E2水平,增加HCG日子宫内膜的容受性,提高种植率、临床妊娠率和活产率,可作为PCOS患者行IVF-ET治疗降调节方案的首选。Objective To compare the effect of leuprorelin in the early follicular phase and conventional long down-regulation protocol on the outcome of IVF-ET in the infertile patients with PCOS.Methods A randomized controlled trial was contained 200 infertile patients of PCOS to accept IVF/ICSI-ET treatment between January 2015 and December 2015 in the center for reproductive medicine of Jiangxi maternal and Child health hospital.They were divided to A group(100 cycles applying down-regulation protocol with leuprorelin in the early follicular phase)and B group(100 cycles underwent conventional long down-regulation protocol).Clinical Indicators and outcomes were compared.Results Those were no significantly differences in age,infertility duration,BMI and the level of basic sexual hormone FSH,LH,TT and AMH.The level of LH and E2 on the hCG day in group A were lower than those in group B.Moreover,the 2PN fertility rate in group A was lower than group B.Other parameters included:dosage of Gn,duration of Gn,endometrial thickness on HCG day,levels of P on the day of hCG,number of oocytes retrieved,2PN cleavage rate,whole embryo freezing rate and the OHSS occurred rate,all of which exhibited no significant differences.Conclusion In the infertile women with PCOS,compared with conventional long down-regulation protocol,down-regulation protocol with leuprorelin in the early follicular phase can reduce the level of LH and E2 on the hCG day in the COH process and enhance endometrial receptivity on the hCG day.Much more than this,it can improve clinical pregnancy rate,implantation rate and live birth rate.Therefore,it can be used as first choice in IVF/ICSI-ET in the infertile patients with PCOS.

关 键 词：早卵泡期降调节 亮丙瑞林 多囊卵巢综合征 

分 类 号：R714.8[医药卫生—妇产科学]