促性腺激素释放激素激动剂联合人绒毛膜促性腺激素扳机可改善不良受精结局史患者的体外受精/卵胞质内单精子显微注射治疗结局  

Gonadotropin releasing hormone agonist and standard dosage of human chorionic gonadotropin trigger improve the in vitro fertilization and embryo transfer/intracytoplasmic sperm injection treatment prognosis of patients with history of poor fertilization outcomes

作　　者：杨硕[1] 梁靓[1] 何艺磊[1] 陈新娜[1] 王颖[1] 李红真[1] 李蓉[1] 王海燕[1] Yang Shuo;Liang Liang;He Yilei;Chen Xinna;Wang Ying;Li Hongzhen;Li Rong;Wang Haiyan(Reproductive Medical Science Center,Obstetrics and Gynecology Department,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》2019年第3期185-190,共6页Chinese Journal of Reproduction and Contraception

摘　　要：目的比较有不良受精结局史患者前后2次不同治疗方案体外受精(IVF)/卵胞质内单精子显微注射(ICSI)治疗结局,探索促性腺激素释放激素激动剂(GnRH-a)联合标准剂量人绒毛膜促性腺激素(hCG)扳机在拮抗剂方案中的应用是否能改善治疗结局。方法回顾性自身对照研究,分析2014年1月1日—2015年12月31日在北京大学第三医院生殖医学中心接受IVF/ICSI助孕,行GnRH拮抗剂(GnRH-A)灵活方案及GnRH-a联合标准剂量hCG扳机的71例患者临床资料,既往有接受标准剂量hCG扳机后,因受精率低或无优质胚胎致妊娠失败病史。对患者2次治疗过程及结局进行比较分析。结果患者初次接受IVF治疗年龄为(31.8±3.9)岁,范围为20~40岁,原发不孕占78.9%。GnRH-a联合标准剂量hCG扳机组促性腺激素(Gn)起始剂量[(258.4±93.7)IU]高于hCG扳机组[(215.0±90.7)IU],但Gn使用时间较短[(10±1)d比(12±3)d,P均<0.001],联合扳机组Gn使用总量[(2472.0±913.6)IU]低于hCG扳机组[(2846.8±1243.2)IU,P=0.001]。联合扳机的获卵数(14±9)和ICSI授精率(76.1%)均显著高于hCG扳机组(12±6,38.1%,P值分别为0.022及<0.001)。2种治疗方案MII卵率差异无统计学意义(P>0.05)。联合扳机组的受精率(54.6%)、2原核(PN)率(45.8%)均显著高于hCG扳机组(38.1%,25.3%,P均<0.001)。联合扳机组临床妊娠率(44.6%)、着床率(29.4%)及活产率(35.7%)均显著高于hCG扳机组(2.5%,1.4%,0,P均<0.001)。结论对于既往IVF治疗失败的低受精率或无优质胚胎史的患者,采用GnRH-a联合标准剂量hCG扳机的拮抗剂方案,能显著改善治疗结局。Objective To investigate whether combined trigger[gonadotropin releasing hormone(GnRH)agonist(GnRH-a)combined with standard dosage human chorionic gonadotropin(hCG)trigger]in GnRH antagonist protocol could improve the treatment outcomes of patients with history of poor fertilization outcomes(low fertilization rate or no valuable embryo due to poor oocyte quality).Methods This was a retrospective self-controlled study.The study period was between Jan.1st 2014 and Dec.31st 2015.All patients were accepted GnRH antagonist flexible protocol and GnRH-a and standard dosage of hCG trigger with hisory of poor fertilization outcomes followed standard hCG trigger.The relative data were analyzed.Results The age was(31.8±3.9)(range from 20 to 40)years old,78.9%of them were primary infertility.Compared with hCG trigger group,the initial dosage of gonadotropin(Gn)used was significantly higher in combined trigger group[(258.4±93.7)IU vs.(215.0±90.7)IU,P=0.001]and the duration of Gn used stimulation was significantly shorter in combined trigger group[(10±1)d vs.(12±3)d,P<0.001).The total dosage of Gn used was significantly lower in combined trigger group[(2 472.0±913.6)IU vs.(2 846.8±1 243.2)IU,P=0.001].The number of oocyte pick up and fertilization rate were significantly higher in combined trigger group(14±9 vs.12±6,54.6%vs.38.1%,respectively,P=0.022,P<0.001).The rate of MII oocyte was comparable between the two groups.The 2 pronucleus(PN)oocyte rate was significantly higher in combined group(45.8%vs.25.3%,P<0.001).The clinical pregnancy rate,the implantation rate and the live birth rate were significantly higher in combined trigger group(44.6%vs.2.5%,29.4%vs.1.4%,35.7%vs.0,respectively,all P<0.001).Conclusion The GnRH antagonist protocol with GnRH-a and standard dosage of hCG trigger significantly improve the live birth rate of patients with history of low fertilization rate or no valuable embryo due to poor oocyte quality.

关 键 词：促性腺激素释放激素拮抗剂 控制性卵巢刺激 联合扳机 促性腺激素释放激素激动剂扳机 

分 类 号：R714.8[医药卫生—妇产科学]