黄体期添加短效GnRH-a在IVF新鲜周期中的应用  

Application of GnRH agonist in fresh IVF cycle

作　　者：李惠敏[1] 李红[1] 孟庆霞[1] 邹琴燕[1] 王玮[1] 许咏乐[1] LI Hui-min;LI Hong;MENG Qing-xia;ZOU Qin-yan;WANG Wei;XU Yong-le(The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院生殖中心,苏州215002

出　　处：《生殖医学杂志》2019年第5期494-499,共6页Journal of Reproductive Medicine

基　　金：江苏省医学创新团队项目(CXTDB2017013)

摘　　要：目的探讨黄体期添加短效促性腺激素释放激素激动剂(GnRH-a)对IVF新鲜周期妊娠结局的影响。方法回顾性分析2015年1月至2018年1月我中心第1次行IVF-ET的新鲜周期移植患者618例。所纳入患者根据促排卵方案不同,分为长方案组(437例)和拮抗剂方案组(181例);又以黄体期是否添加短效GnRH-a分为对照组(402例)和达必佳组(216例)。长方案组和拮抗剂方案组中又根据是否添加短效GnRH-a,分别分为4个亚组:长方案-达必佳组(A组)、长方案-对照组(B组)和拮抗剂-达必佳组(C组)、拮抗剂-对照组(D组)。比较不同组间和不同亚组间的妊娠结局及并发症发生情况。结果达必佳组和对照组患者的获卵数及2PN数比较无显著性差异(P>0.05);达必佳组移植胚胎数显著少于对照组(P<0.05),胚胎种植率及临床妊娠率有高于对照组的趋势,但尚无显著性差异(P>0.05);两组的早期流产率、异位妊娠率及卵巢过度刺激综合征(OHSS)发生率比较均无显著性差异(P>0.05)。长方案组437例患者中,A、B组间胚胎种植率、临床妊娠率、持续妊娠率、早期流产率、异位妊娠率及OHSS发生率比较均无显著性差异(P>0.05)。拮抗剂方案组181例患者中,C组的胚胎种植率及临床妊娠率均显著高于D组(P<0.05)。两组的早期流产率、异位妊娠率及OHSS发生率均无统计学差异(P>0.05)。结论鲜胚移植IVF周期中黄体中期添加短效GnRH-a可能增加胚胎种植率及临床妊娠率,特别是在拮抗剂方案中。但由于本研究是回顾性分析,受诸多因素影响,还需要扩大临床数据进一步加以验证。Objective:To investigate the effect of adding GnRH agonist(GnRH-a)on the outcome in fresh IVF cycle.Methods:A retrospective analysis was made on 618 patients in fresh IVF-ET cycle in our center from Jan.2015 to Jan.2018.The included patients were divided into long-term protocol group(n=437)and antagonist protocol group(n=181)according to the ovulation induction protocol.In addition,the patients were divided into the control group(n=402)and the Decapepthl group(n=216)according to if shortacting GnRH-a was added to the luteal phase.The long-term protocol group and the antagonist protocol group were subdivided into four subgroups according to whether or not short-acting GnRH-a was added:long-term protocol-Decapepthl group(group A),long-term protocol-control group(group B),and antagonist-Decapepthl group(group C),antagonist-control group(group D).The pregnancy outcomes and complications were compared among the groups.Results:There was no significant difference in the number of oocytes retrieved and 2 PN embryos between the Decapepthl group and the control group(P>0.05).The number of embryo transfer in Decapepthl group was significantly less than that in control group(P<0.05).The embryo implantation rate and clinical pregnancy rate in Decapepthl group were higher than those of the control group,but there was no significant difference(P>0.05).There were no significant differences in early abortion rate,ectopic pregnancy rate,and incidence of ovarian hyperstimulation syndrome(OHSS)between the two groups.Among the 437 patients in the long-term group,there were no significant differences in the embryo implantation rate,clinical pregnancy rate,continued pregnancy rate,early abortion rate,ectopic pregnancy rate and OHSS between groups A and B(P>0.05).Among the 181 patients in the antagonist group,the embryo implantation rate and clinical pregnancy rate of group C were significantly higher than those of group D(P <0.05).However,there were no significant differences in early abortion rate,ectopic pregnancy rate and OHSS incid

关 键 词：体外受精-胚胎移植 促性腺激素释放激素激动剂 黄体支持 

分 类 号：R711.6[医药卫生—妇产科学]