促性腺激素释放激素拮抗剂方案改善助孕反复失败的卵巢低反应患者胚胎质量及体外受精结局的自身对照研究  

Gonadotropin-releasing hormone antagonist protocol improves embryo quality and in vitro fertilization outcomes in poor ovarian response patients with repeated in vitro fertilization failure: a self-controlled study

作　　者：王薇[1] 杨婷[1] 何佳静[1] 马晓玲[1] 赵丽辉[1] 胡俊平[1] 薛石龙[1] 张学红[1] Wang Wei;Yang Ting;He Jiajing;Ma Xiaoling;Zhao Lihui;Hu Junping;Xue Shilong;Zhang Xuehong(The Reproductive Medicine Special Hospital of the 1st Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzou 730000, China)

机构地区：[1]兰州大学第一医院生殖医学专科医院甘肃省生殖医学与胚胎重点实验室,730000

出　　处：《中华生殖与避孕杂志》2019年第6期490-494,共5页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨促性腺激素释放激素激动剂(GnRH-a)长方案助孕的卵巢低反应(POR)患者失败后改用促性腺激素释放激素拮抗剂(GnRH-A)方案促排卵对胚胎质量及体外受精(IVF)结局的改善效果。方法回顾性分析2017年2月—2018年2月期间在兰州大学第一医院生殖医学专科医院53例POR患者GnRH-a长方案助孕失败后改用GnRH-A方案的前后自身对照研究,比较两种方案的促性腺激素(Gn)使用时间、Gn使用总量、hCG注射日雌二醇、hCG注射日黄体生成素(LH)、hCG注射日孕酮、hCG注射日子宫内膜厚度、获卵数、受精率、卵裂率、可移植胚胎数、优质胚胎率、移植胚胎数、移植日子宫内膜厚度、种植率、周期取消率,计算GnRH-A组的临床妊娠率。结果GnRH-A组的Gn使用时间[(11.3±3.4) d]、Gn使用总量[(2 827.6±427.4) IU]、hCG注射日LH[(1.24±0.76) IU/L]、周期取消率(5.66%)与GnRH-a长方案组[(13.7±3.7) d,P<0.001;(3 824.8±682.4) IU,P=0.037;(3.12±2.21) IU/L,P<0.001;7.55%,P=0.027]相比均显著下降;获卵数(4.4±2.1)、优质胚胎率(45.98%)、种植率(31.55%)与GnRH-a长方案组(3.4±2.0,P=0.035;40.23%,P=0.031;27.45%,P=0.041)相比均显著增加;而hCG注射日雌二醇、hCG注射日孕酮、hCG注射日子宫内膜厚度、受精率、卵裂率、可移植胚胎数、移植胚胎数、移植日子宫内膜厚度组间差异均无统计学意义(P>0.05);GnRH-A组的临床妊娠率为32.00%。结论POR患者采用GnRH-a长方案助孕失败后应用GnRH-A方案促排卵有助于改善胚胎质量及IVF结局。Objective To discuss the effect of gonadotropin-releasing hormone antagonist (GnRH-A) protocol on the improvement of embryo quality and pregnancy outcome after the pregnancy failure of gonadotropin-releasing hormone agonist (GnRH-a) protocol performed for the poor ovarian response (POR) patients who suffered repeated in vitro fertilization (IVF) failure accompanied by poor embryo quality. Methods A self-controlled study was carried out retrospectively to analyze 53 POR patients who switch to GnRH-A protocol after the pregnancy failure performed by the GnRH-a protocol in the Reproductive Medicine Special Hospital of the 1st Hospital of Lanzhou University from February 2017 to February 2018. The duration of gonadotropin (Gn) used, total dosage of Gn used, the levels of estradiol, luteinizing hormone (LH) and progesterone on the day of hCG injection, endometrial thickness on the day of hCG injection, No. of oocytes retrieved, fertilization rate, cleavage rate, No. of embryos obtained for embryo transfer, rate of high-quality embryos, No. of embryos transferred, endometrial thickness on the day of embryo transfer, implantation rate, cancelling rate between GnRH-A and GnRH-a groups were compared, and the clinical pregnancy rate of GnRH-A group was also calculated. Results The duration of Gn used [(11.3±3.4) d], total dosage of Gn used [(2 827.6±427.4) IU], LH level on the day of hCG injection [(1.24±0.76) IU/L], cancelling rate (5.66%) of GnRH-A group were significantly lower than those of GnRH-a group [(13.7±3.7) d, P<0.001;(3 824.8±682.4) IU, P=0.037;(3.12±2.21) IU/L, P<0.001;7.55%, P=0.027]. No. of oocytes retrieved (4.4±2.1), rate of high-quality embryos (45.98%), implantation rate (31.55%) of GnRH-A group were significantly higher than those of GnRH-a group (3.4±2.0, P=0.035;40.23%, P=0.031;27.45%, P=0.041). There were no significant differences in the estradiol and progesterone on the day of hCG injection, endometrial thickness on the day of hCG injection, fertilization rate, cleavage rate, No. of embryo

关 键 词：促性腺激素释放激素拮抗剂 卵巢低反应 胚胎质量 受精 体外 自身对照研究 

分 类 号：R714.8[医药卫生—妇产科学]