卵泡期长效长方案改善子宫内膜异位症患者IVF/ICSI的临床结局  

Follicular phase long-acting gonadotropin-releasing hormone agonist long protocol could improve IVF/ICSI outcomes of patients with endometriosis

作　　者：李文澍 包洪初 张伟[1] 赵慧珊 刘雪梅[1] Li Wenshu;Bao Hongchu;Zhang Wei;Zhao Huishan;Liu Xuemei(Reproductive Medicine Center,Yantai Yuhuangding Hospital,Affiliated Hospital of Qingdao University,Yantai 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院生殖医学中心,266000

出　　处：《中华生殖与避孕杂志》2021年第6期496-502,共7页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金(81601276);烟台市科技发展计划项目(2020YD006)。

摘　　要：目的:探讨卵泡期长效长方案在子宫内膜异位症患者体外受精( in vitro fertilization,IVF)/卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)助孕过程中的作用。 方法:回顾性队列研究分析2015年7月1日至2019年6月30日期间在青岛大学附属烟台毓璜顶医院生殖医学中心第一次行IVF/ICSI助孕的383例子宫内膜异位症患者的临床资料。根据促排卵方案将患者分为卵泡期长效方案组(A组)、长方案组(B组)和拮抗剂方案组(C组),采用单因素分析和多因素logistic回归分析比较各组患者的临床结局。结果:A组与B组和C组相比,促性腺激素(gonadotropin,Gn)启动日和人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日的血清促黄体生成素(luteinizing hormone,LH)水平[0.64(0.35,0.99) IU/L比1.78(1.42,2.05) IU/L比5.00(3.63,6.46) IU/L;0.89(0.37,1.33) IU/L比2.48(1.76,3.25) IU/L比2.46(1.66,3.67) IU/L]和雌二醇水平[6.70(5.00,16.90) μg/L比7.93(6.50,7.93) μg/L比34.05(22.99,45.58) μg/L;1.82(1.11,2.75) μg/L比2.97(2.16,4.24) μg/L比2.03(1.49,2.96) μg/L]显著降低( P均<0.001);Gn使用总量[2700(2250,3200) IU比1875(1575,2250) IU比1800(1425,2250) IU]和Gn使用时间[11(9,13) d、9(8,10) d和8(8,9) d]显著增加( P均<0.001);临床妊娠率[76.53%(75/98)、61.39%(62/101)和54.39%(31/57), P=0.010]、胚胎种植率[54.10%(99/183)、42.63%(81/190)和40.19%(43/107), P=0.029]和活产率[66.33%(65/98)、53.47%(54/101)和47.37%(27/57), P=0.046]显著提高。 结论:与长方案和拮抗剂方案相比,卵泡期长效长方案能改善子宫内膜异位症患者IVF/ICSI的临床结局。Objective To investigatetheeffectof follicular phase long-actinggonadotropin-releasing hormone(GnRH)agonist long protocol on in vitro fertilization(IVF)/intracytoplasmic sperminjection(ICSI)outcomesof patients withendometriosis(EMS).MethodsThis retrospective cohort study was carried out from July 1st 2015 to June 30th 2019and enrolled 383 young patients with EMS who underwent the first IVF/ICSI.According to thecontrolled ovarian hyperstimulation protocols,patients were classified into three groups:follicularphase long-acting GnRH agonist long protocol group(group A),short-acting GnRH agonist longprotocol group(group B)and GnRH antagonist protocol group(group C).The clinical outcomes of IVF/ICSI were compared among the groups by using univariate and multivariate logistic regression analyses.ResultsThe patients with EMS in group A had significantly higher duration of stimulation and totaldosage of gonadotrophin(Gn)used[11(9,13)d,2700(2250,3200)IU]than those in group B andgroup C[9(8,10)d,1875(1575,2250)IU;8(8,9)d,1800(1425,2250)IU](all P<0.001).Serum levelsof luteinizing hormone(LH)[0.64(0.35,0.99)IU/L vs.1.78(1.42,2.05)IU/L vs.5.00(3.63,6.46)IU/L;0.89(0.37,1.33)IU/L vs.2.48(1.76,3.25)IU/L vs.2.46(1.66,3.67)IU/L]and estradiol[6.70(5.00,16.90)μg/L vs.7.93(6.50,7.93)μg/L vs.34.05(22.99,45.58)μg/L;1.82(1.11,2.75)μg/L vs.2.97(2.16,4.24)μg/L vs.2.03(1.49,2.96)μg/L)]on Gn initiation day and human chorionic gonadotropin(hCG)injection day were significantly lower in group A(all P<0.001).Group A had significantly higher clinicalpregnancy rate[76.53%(75/98)],implantation rate[54.10%(99/183)]and live birth rate[66.33%(65/98)]compared with those in group B and group C[61.39%(62/101)and 54.39%(31/57),P=0.010;42.63%(81/190),and 40.19%(43/107),P=0.029;53.47%(54/101),and 47.37%(27/57),P=0.046].ConclusionFollicular phase long-acting GnRH agonist protocol could improve IVF/ICSI outcomes ofpatients with EMS compared with short acting GnRH agonist long protocol and GnRH antagonist protocol.

关 键 词：子宫内膜异位症 受精 体外 长效促性腺激素释放激素激动剂 临床妊娠率 

分 类 号：R711.71[医药卫生—妇产科学]