两种长效促性腺激素释放激素激动剂在早卵泡期超长方案中助孕结局比较  

Comparison of the assisted-reproduction outcomes of two long-acting gonadotropin-releasing hormone agonists in the long-term early follicular phase

作　　者：龚超超 吴燕虹[2] 苏玮珏 陈豪英 习海涛[2] 赵军招[2] Gong Chaochao;Wu Yanhong;Su Weijue;Chen Haoying;Xi Haitao;Zhao Junzhao(The Second Clinical College of Wenzhou Medical University,Wenzhou 325027,China;the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学第二临床学院,325027 [2]温州医科大学附属第二医院生殖医学中心,325000

出　　处：《中华生殖与避孕杂志》2021年第1期18-24,共7页Chinese Journal of Reproduction and Contraception

基　　金：温州市生殖遗传重点创新团队项目(C20170007)。

摘　　要：目的比较两种长效促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRH-a)在早卵泡期超长方案中对体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)的助孕结局。方法回顾性队列研究分析2019年3月1日至2019年7月31日期间在温州医科大学附属第二医院生殖医学中心采用两种不同GnRH-a在早卵泡期超长方案的患者共802例,根据长效GnRH-a的不同分为醋酸亮丙瑞林组(A组)和曲普瑞林组(B组),比较两组患者的临床和实验室结局。结果两组患者年龄、不孕年限、体质量指数(body mass index,BMI)、基础性激素水平、不孕类型,促性腺激素(gonadotropin,Gn)启动日性激素水平、Gn使用时间及总量、降调节时间、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日雌二醇水平及子宫内膜厚度、移植胚胎数、临床结局、治疗总费用,以及因内膜厚度不均、孕酮升高、胚胎质量问题、个体因素而取消移植率等比较,差异均无统计学意义(P>0.05)。但B组窦卵泡计数(antral follicle count,AFC)(19.59±7.93)、获卵数[(15.39±7.59)枚]、受精数[(11.20±6.53)枚]、卵裂数[(10.85±6.42)枚]、第3日优质胚胎数[(3.01±2.66)枚]、囊胚数[(5.27±4.02)枚]大于A组[17.68±7.23、(13.70±6.94)枚、(9.50±5.43)枚、(9.26±5.34)枚、(2.57±2.33)枚、(4.49±3.40)枚](P=0.001,P=0.002,P<0.001,P=0.001,P=0.017,P=0.007)。A组hCG注射日黄体生成素(luteinizing hormone,LH)[(0.78±0.64)IU/L]、孕酮水平[(0.72±0.39)μg/L]高于B组[(0.55±0.30)IU/L、(0.64±0.36)μg/L](P<0.001,P=0.005),A组为防止卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)的发生取消移植率[28.52%(75/263)]高于B组[14.95%(16/107),P=0.006]。结论两种长效GnRH-a药物应用于早卵泡期超长方案均可获得满意的降调节效果、实验室及临床结局,但醋酸亮丙瑞林对垂体抑制相对温和,相比较于曲普瑞林获得的Objective To compare the assisted-reproduction outcomes of two long-acting gonadotropin-releasing hormone agonists(GnRH-a)in patients undergoing in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)during the long-term early follicular phase.Methods A retrospective cohort study was conducted in the Reproductive Center of the Second Affiliated Hospital of Wenzhou Medical University from March 1,2019 to July 31,2019.A total of 802 patients were divided into leuprorelin acetate group(group A)and triptorelin group(group B)according to the difference of long-acting GnRH-a in the long-term early follicular phase,and the clinical and laboratory outcomes between the two groups were compared.Results There were no significant differences in age,infertility duration,body mass index(BMI),basic hormone levels,infertility type,sex hormone level on the day of initiation of injection of gonadotropin(Gn),total duration and dosage of Gn used,duration of down-regulation,estradiol level and endometrial thickness on hCG injection day,the number of embryos transferred,clinical outcomes,total treatment cost,and owing to the uneven inner membrane,elevated progesterone,embryo quality problems,individual factors resulting in cancelling the transplant,between the two groups(P>0.05).However,antral follicle count(AFC)(19.59±7.93),the number of retrieved oocytes(15.39±7.59),fertilized oocytes(11.20±6.53),cleaved oocytes(10.85±6.42),good-quality embryos on Day 3(3.01±2.66),and blastocysts(5.27±4.02)in group B was larger than that in group A(17.68±7.23,13.70±6.94,9.50±5.43,9.26±5.34,2.57±2.33,4.49±3.40)(P=0.001,P=0.002,P<0.001,P=0.001,P=0.017,P=0.007).The levels of luteinizing hormone(LH)[(0.78±0.64)IU/L]and progesterone[(0.72±0.39)μg/L]on hCG injection day in group A were higher than those in group B[(0.55±0.30)IU/L,(0.64±0.36)μg/L](P<0.001,P=0.005).The rate of preventing the occurrence of ovarian hyperstimulation syndrome(OHSS)in group A[28.52%(75/263)]was higher than that in group B[14.95%(16/107),P=0.006].Concl

关 键 词：促性腺激素释放激素激动剂 早卵泡期超长方案 受精 体外 卵胞质内单精子注射 选择性单囊胚移植 

分 类 号：R714.8[医药卫生—妇产科学]