卵巢储备功能减退患者中GnRHa扳机方案的胚胎培养结局分析  

Efficiency of GnRH agonist trigger on embryo cultural outcomes in IVF subjects with diminished ovarian reserve

作　　者：张岭[1] 徐维海[1] 黄琼晓[1] 傅晓华[1] 张琳[1] 李施施[1] 朱晶[1] 吴瑞芳 舒静[1] ZHANG Ling;XU Weihai;HUANG Qiongxiao;FU Xiaohua;ZHANG Lin;LI Shishi;ZHU Jing;WU Ruifang;SHU Jing(Department of Reproductive Endocrinology and Infertility,People's Hospital of Zhejiang Province/ People's Hospital Affiliated to Hangzhou Medical College,Hangzhou 310014,Zhejiang,China)

机构地区：[1]浙江省人民医院/杭州医学院附属人民医院生殖内分泌科

出　　处：《中国临床药理学与治疗学》2019年第7期799-804,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省自然科学基金(LY15H260004、LY17H040014);浙江省医药卫生科技计划(2014ZDA004、2015ZDA003);浙江省新世纪“151人才工程”项目

摘　　要：目的:比较促性腺激素释放激素激动剂(gonadotropin releasing hormone agonist,GnRHa)和人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)两种不同扳机方案对卵巢储备功能减退(diminished ovarian reserve,DOR)患者体外受精培养结局的影响,评估GnRHa扳机方案用于DOR患者的效率。方法:以本院生殖中心行体外受精(IVF)治疗的DOR患者为对象,排除只适合hCG扳机的患者(如降调方案),根据扳机方案分为GnRHa和hCG组。比较GnRHa扳机与hCG扳机后取卵、受精和胚胎培养结果,包括获卵情况、卵子成熟率、受精率、可用胚胎率和优质胚胎率等。结果:GnRHa组与hCG组相比,在年龄、体质指数(BMI)、卵巢基础功能指标、不孕原因及不孕年限、治疗相关参数等方面均无显著性差异;GnRHa组的正常受精率(%卵数)、可利用胚胎率(%卵数)和优质胚胎率(%卵数)分别为 73.03%、 63.10%和 42.24%,明显高于hCG组;但在使用广义估计方程平衡年龄、卵巢储备功能、不孕因素以及治疗方案后,两组的正常受精率、可利用胚胎率和优质胚胎率无显著差异。结论:在DOR患者中,GnRHa扳机的实验室培养结局与hCG扳机组无显著差异,但仍需进一步扩大样本作深入论证。AIM : To compare the effect of two trigger protocols-GnRH agonist and hCG on in vitro fertilization cultural outcome in patients with diminished ovarian reserve (DOR). METHODS : The patients with DOR undertaking the first cycle of IVF treatment in our IVF center were recruited for this study, and those with GnRH antagonist down-regulation stimulation excluded. All subjects were analyzed in two groups-GnRHa and hCG. The outcomes of oocyte retrieval, normal fertilization, embryo development were compared between the two groups. RESULTS :Comparison of GnRHa and hCG between the two groups showed no significant difference in age, BMI, index of basal function of ovary and the related parameters of treatment. In group GnRHa, the normal fertilization rate (% egg number), available embryo rate (% egg number), good embryo rate (% egg number) and good embryo per embryo were 73.03%, 63.10% and 42.24% respectively, which were significantly higher than those of the hCG. However, the aforementioned significance did not existed after applying the model of generalized estimation equation for the balancing age, ovarian reserve function, infertility factors and treatment regimen. CONCLUSION :GnRHa trigger may result in an equal laboratory culture outcomes to hCG, which need to be further confirmed by prospective studies.

关 键 词：扳机方案 促性腺激素释放激素激动剂 人绒毛膜促性腺激素 培养结局 体外受精 

分 类 号：R711.75[医药卫生—妇产科学] R321[医药卫生—临床医学]