不同扳机方案对卵巢高反应人群胚胎质量的影响比较  

Comparison the effect of different method of triggering medicine on the embryo quality of ovarian hyper responsiveness women

作　　者：罗燕群[1] 朱秀兰[1] 黄莉[1] 张曦倩[1] 董梅[1] 刘风华[1] LUO Yanqun;ZHU Xiulan;HUANG Li;ZHANG Xiqian;DONG Mei;LIU Fenghua(Cen-ter for Reproductive Medicine,Guangdong Women and Children Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院生殖医学中心,广州511400

出　　处：《实用医学杂志》2020年第15期2108-2113,共6页The Journal of Practical Medicine

基　　金：广州市科技计划(编号:201704020217);广东省医学科学技术研究基金(编号:B2019019)。

摘　　要：目的探讨促性腺激素释放激素激动剂(gonadotrophin-releasing hormone agonist,GnRHa)联合小剂量hCG双扳机和GnRHa单扳机诱发排卵对卵巢高反应患者胚胎质量的影响。方法共纳入2015年1月至2018年10月采用拮抗剂方案治疗的287个IVF/ICSI周期,按扳机方式分A组(GnRHa+hCG)和B组(GnRHa),B组按扳机次日促黄体激素(luteinizing hormone,LH)水平细分B1组(LH <40 IU/L)、B2组(LH 40~79.9 IU/L)和B3组(LH≥80 IU/L)。最后hCG日LH不同水平(≤1.99 IU/L、2.0~2.99 IU/L和≥3.0 IU/L)患者分别按扳机方式分GnRHa+hCG组和GnRha组。比较获卵率、优质胚胎率等结果。结果 A组患者获卵率和优胚率明显高于B组(P<0.05),且中重度卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)发生率未明显增高(P>0.05)。B1、B2和B3组间hCG日LH水平、获卵率和优胚率依次明显增加(P<0.05)。hCG日LH≤1.99 IU/L患者采用双扳机获卵率和优胚率均较GnRha单扳机患者明显升高(P<0.05);hCG日≥2.0 IU/L患者采用双扳机虽然获卵率较GnRha单扳机明显升高(P<0.05),但优胚率间差异无明显统计学意义。结论 hCG日LH≤1.99 IU/L的卵巢高反应妇女GnRHa诱发排卵时添加小剂量hCG可能增加获卵率和优胚率。Objective To investigate whether dual trigger of final oocyte maturation may optimize embryo quality for high ovarian responders compared with gonadotrophin-releasing hormone agonist(GnRHa) triggered alone.Methods A retrospective cohort of 287 IVF/ICSI cycles between Jan 2015 and October 2018 were study.According to the different method of triggering medicine,patients were divided into group A(GnRHa plus hCG)and group B(GnRHa).According to their serum LH level 8-12 hours after GnRHa trigger alone patients of group B were divided into group B1(LH <40 IU/L),group B2(LH 40~79.9 IU/L) and group B3(LH ≥80 IU/L).According to triggering medicine,patients were divided into dual trigger group and GnRHa trigger group at different serum LH levels on day of hCG(≤1.99 IU/L,LH 2.0~2.99 IU/L and ≥ 3.0 IU/L group).Results The rate of oocyte retrieval and high quality embryo in group A was significantly higher than those in group B(P <0.05),but the rate of the moderate and severe OHSS was not increase significantly.Among the group B1,B2 and B3,there were significant differences in the LH level on the day of hCG,rate of oocyte retrieval and the rate of high-quality embryos.For patients with LH level ≤ 1.99 IU/L on day of hCG,the rate of oocyte retrieval and good embryos of dual trigger group were significantly higher than those of GnRha trigger group.For patients with LH level) 2.0 IU/L on day of hCG,the rate of oocyte retrieval of dual trigger group was significantly higher than that of GnRha trigger group,but the rate of good embryos was similar.Conclusion In order to increase the rate of oocyte retrieval and good embryos,patients with LH level≤1.99 IU/L on day of hCG were advised to choose dual triggering with GnRHa 0.2 mg plus HCG 2000 IU.

关 键 词：GNRHA 双扳机 卵巢过度刺激综合征 优胚率 卵巢高反应 

分 类 号：R711.6[医药卫生—妇产科学]